Job DetailsJob Location: Guayaquil, Ecuador - Guayaquil, Ecuador, FL 33126 POSITION PURPOSE: Effectively and accurately applies policy conditions of coverage, processing guidelines and cost containment knowledge into the adjudication of global health claims and comprehensive cases. ESSENTIAL JOB DUTIES AND RESPONSIBILITIES: Processes all types of global health insurance claims Conduct claims analysis reviewing in detail claim documentation, medical reports and supporting documentation to decide compensability Examine with accuracy policy and member information, plan conditions of coverage and processing guidelines against claim documentation to determine benefit application Conduct post claim underwriting reviews to identify possible pre-existing condition Utilize anti-fraud policies to mitigate fraud possibility for submitted claims Review benefit letter / medical authorizations for cost and benefit application Evaluate claim compensability based on procedures performed, treatment intensity and diagnosis Validate benefit accumulators, patient responsibility, duplicate claim prevention and provider discount Assign ICD-10 codes along with valid procedure codes when necessary Apply Usual, Customary and Reasonable pricing guidelines to determine acceptable claim cost Maintain acceptable productivity and turnaround times for all assignments Maintain high work accuracy and quality scores Support team with versatile assignments related to department needs QualificationsDESIRED MINIMUM QUALIFICATIONS: Proficiency in Microsoft product suite (i.e. Microsoft Office, Word, Excel, etc.) Strong analytical, problem solving and negotiating skills Ability to adapt quickly in fast paced environment Detail oriented with exceptional organizational and communication skills Complete Fluency in English, Spanish (Portuguese a plus) Proven ability to work independently and meet determined deadlines Ability to navigate and enter data utilizing multiple systems and screens Education and Experience: Associates Degree or commensurate work experience Billing/Coding Certification preferred Minimum of 3 years experience in Health Insurance Industry #J-18808-Ljbffr BEST DOCTORS INSURANCE SERVICES LLC
Automation Engineer - ABB Robotics & PLC Systems IntegrationUp to $120,000 Base Salary + Benefits Waukesha County, WI Area Onsite / Up to 30% Travel Direct-HirePay & Incentives: Up to $120,000 starting base salary (commensurate with programming depth) + full corporate...
...clinical protocols and evidence-based best practices. Utilize telemedicine platforms, AI documentation tools, and digital healthcare... ...on licensure) Qualifications Required Active Nurse Practitioner (NP) or Physician Assistant (PA) license (Exceptional MD/DO...
...Bank Branch Manager Baton Rouge, LALead a Team. Build Relationships. Make an Impact.A well-established community bank in Baton Rouge... ...procedures, and regulatory requirements.Oversee branch security, cash management, audits, and operational controls.Resolve customer concerns...
...Seeking a detail-oriented Remote Shopify Developer, this full-time position involves building, customizing, and optimizing eCommerce websites on the Shopify platform, with responsibilities including theme development, performance optimization, and integration of third-...
...recruitment agency is actively seeking a 1st Receptionist for TUI Cruises. The role involves overseeing the reception area, managing guest... ...work, competitive salary, free meals, and shared accommodation on modern river ships traveling through Europe.#J-18808-Ljbffr...