Claims Associate Representative - EviCore

Accountabilities: Review, research, and process accounts receivable claims accurately and within established deadlines. Investigate denied, delayed, and underpaid medical claims to identify root causes, discrepancies, and opportunities for resolution. Determine and implement appropriate corrective actions to resolve outstanding claim balances and support accurate reimbursement. Conduct outbound calls to third-party insurance payers, healthcare providers, and internal departments to address claim-related questions and resolve outstanding issues. Maintain detailed and accurate documentation of all claim-related activities in accordance with established organizational standards. Monitor claim statuses and perform timely follow-ups to ensure outstanding balances are resolved and payments are received promptly. Identify complex claims or unresolved discrepancies and escalate them to senior representatives or management when appropriate. Maintain up-to-date knowledge of payer policies, compliance requirements, internal procedures, and accounts receivable practices. Apply sound judgment and analytical skills when reviewing claim information and determining appropriate next steps. Requirements: High school diploma or GED required. At least 2 years of experience in medical claims processing, claims handling, and/or accounts receivable operations. At least 2 years of experience in account reconciliation and financial analysis is highly preferred. Ability to interpret Explanation of Benefits (EOBs) and Explanation of Payment (EOPs) documents. Proficiency in Microsoft Office applications, particularly Word, Outlook, and Excel. Strong analytical and problem-solving skills, with the ability to investigate discrepancies and resolve complex claim-related issues. Excellent attention to detail and a high level of accuracy when processing financial and medical claim information. Strong planning, organizational, and time management skills, with the ability to manage multiple priorities effectively. Excellent written and verbal communication skills, particularly when interacting with insurance payers, healthcare providers, and internal stakeholders. Ability to work independently while collaborating effectively with colleagues and cross-functional teams. Comfortable working in a fast-paced environment while maintaining productivity, accuracy, and quality standards. Strong documentation skills and the ability to maintain clear, organized records. Basic mathematical skills, including the ability to perform calculations and reconcile account balances. For remote work, access to a cable broadband or fiber-optic internet connection with minimum speeds of 10 Mbps download and 5 Mbps upload is required. Benefits: Compensation: Anticipated hourly pay ranging from $17.75 to $24 USD, depending on relevant experience and geographic location. Annual bonus: Eligibility to participate in an annual bonus plan. Healthcare coverage: Medical, dental, and vision insurance available from the first day of employment. Well-being support: Access to behavioral health and well-being programs. Retirement planning: Access to a 401(k) savings plan. Life insurance: Company-paid life insurance coverage. Professional development: Tuition reimbursement opportunities. Paid time off: At least 18 days of paid time off annually, in addition to paid holidays. Additional leave: Access to various leave-of-absence programs. Work flexibility: Fully remote working arrangement within the United States. How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1