PHRN (Associate - Accidental Claims) | Hybrid | Urgent

Work schedule: Nightshift (starts anytime between 9:00 pm and 12:00 pm) Weekends off

Work set-up: Onsite Training (2-3 months) then possibility of a hybrid setup (conditions apply)

Requirements: 

• Bachelors degree in nursing. PHRN is required
• 1 to 2 years of experience on a similar role, preferably in a fast-paced environment is preferred but not necessary
• Ability to navigate and use Excel, and other Microsoft products.
• Excellent attention to detail, with a strong ability to spot errors and inconsistencies in data.
• Exceptional organizational skills and the ability to multitask effectively.
• Strong verbal and written communication skills.

Job Responsibilities:

• Accidental Claims are worked to a stopping point when pulled and follow 10-day letter process when appropriate.
• Maintain new info and pend tasks within 2-days and all other tasks within 3-days.
• Work tasks to completion and not moving tasks without appropriate work completed.
• Complete timely and thorough claim notes/phone interviews and uploading of all claim documents/MD Guidelines.
• Act on direction provided by your leader and/or Technical Partners. This includes 1x1 conversations, feedback provided in Quality Reviews, Pend Reviews, RN Consults.
• Aggressively manage past due claims while completing timely pend reviews as outlined in the Performance Expectations. If a decision is not able to be made within the latter of 30 days from Mail Received Date, or Accrual date, a decision should be made by day 30.
• Manage BBDA volume of 25% based on total approved claims.