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Claims Examiner I (Work-From-Home)
Adjudication of healthcare claims utilizing employer and payer specific policies and procedures. Responsible for reviewing the data in the claims processing system and compare with corresponding CMS and billing guidelines. Responsible for reviewing medical claims attachments when necessary to determine if services rendered was medically appropriate and benefit coverage criteria has been met. Responsible for reviewing adjudication software system’s claim and line item edits for determination of whether to pay claim/line item(s). May forward claims to specialized internal and external resources. Corresponds with other departments as necessary to process claims. Accountable to performance metric scorecards. This position is full-time, and the starting pay is $15.05/hour ($31,304 annually before overtime). We are opening this opportunity as a remote-work from home position, to candidates anywhere in Nebraska. All candidates need to be available to work a day shift, Monday- Friday, and need to have their own reliable internet service provider. As a work-from-home employee, we expect you to have a dedicated work space and a distraction-free environment that allows you to concentrate on work standards.
Claims Examiner I (Work-From-Home)
Adjudication of healthcare claims utilizing employer and payer specific policies and procedures. Responsible for reviewing the data in the claims processing system and compare with corresponding CMS and billing guidelines. Responsible for reviewing medical claims attachments when necessary to determine if services rendered was medically appropriate and benefit coverage criteria has been met. Responsible for reviewing adjudication software system’s claim and line item edits for determination of whether to pay claim/line item(s). May forward claims to specialized internal and external resources. Corresponds with other departments as necessary to process claims. Accountable to performance metric scorecards. This position is full-time, and the starting pay is $15.05/hour ($31,304 annually before overtime). We are opening this opportunity as a remote-work from home position, to candidates anywhere in Nebraska. All candidates need to be available to work a day shift, Monday- Friday, and need to have their own reliable internet service provider. As a work-from-home employee, we expect you to have a dedicated work space and a distraction-free environment that allows you to concentrate on work standards.
Sr Director and Assistant General Counsel (Attorney)
Supports the Chief Legal Executive/General Counsel in overseeing all legal functions of the organization. Responsibilities include providing legal advice, leading high-functioning legal and related teams, and aligning with, supporting and implementing the organization’s strategy.
Customer Service Representative (Work-From-Home)
As a Customer Service Representative on the Customer Service team you are responsible for handling incoming phone calls and being the primary customer interface for inquiries. Our service representatives inform and educate as well as serve as member advocate, building trust in our abilities and being the voice of the customer. By using established best practices, attending ongoing training and utilizing resources and tools you will serve as the expert to help navigate our members through the challenging world of health insurance. Our representatives must be talented, dedicated people who possess a passion for providing best in class service and want to make a difference in the lives of our member.
Customer Service Representative (Work-From-Home)
As a Customer Service Representative on the Customer Service team you are responsible for handling incoming phone calls and being the primary customer interface for inquiries. Our service representatives inform and educate as well as serve as member advocate, building trust in our abilities and being the voice of the customer. By using established best practices, attending ongoing training and utilizing resources and tools you will serve as the expert to help navigate our members through the challenging world of health insurance. Our representatives must be talented, dedicated people who possess a passion for providing best in class service and want to make a difference in the lives of our member.
Value Based Reimbursement Analyst II
As a Value Based Reimbursement Analyst II you will participate in the development and coordination of innovative programs designed to transition from fee-for-service reimbursement to a system based on value (e.g., Patient Centered Medical Homes, Accountable Care Organizations, pay-for-performance initiatives, payer gain-sharing, bundled payments, etc).  You will provide technical and analytical support for value-based reimbursement programs, including independently analyzing, and monitoring/measuring the performance of the initiatives by leveraging utilization, financial, clinical, and benchmark data from multiple internal and external sources. You will also perform analysis, summarize results, and oversee value-based payments while adhering to established standards and processes.

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