Claims Processor I - Remote

About the role

Sentara Health Plan is currently hiring a Claims Processor I - Remote! Status: Full-time, permanent position (40 hours). Work hours: 8am to 5pm EST, M-F. Location: Candidates may work remotely in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming. Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

Responsibilities

• Responsible for all areas of customer service as it pertains to the acquisition and/or retention of members for Sentara Health Plan, Inc.
• Administration of all group information: processing of claims, interaction with members, providers and employers.
• Special reports and projects to include:
  • Initial review and analysis
  • Recommendations
  • SBAR if assigned
  • Research Team monthly/quarterly reports if assigned
  • Provider site visits/conference calls if assigned
  • New technology testing as assigned

Requirements

• Education: HS - High School Grad or Equivalent (required)
• Certifications/Licenses: None required
• Experience: 1 year of Administrative experience (required)
• Experience: 1 year of Customer Service (required)

Qualifications

• Claims experience preferred

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term