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Reqroute, Inc
Customer Service Representative

Customer Service Representative

Remote

United states

Fresher

Freelance

01-12-2025

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Job Specifications

Claims Processor

Pay: $17.00/hr

Hours: 7:00am – 4:00pm PST

Start Date: December 15th

ROLE: Each associate is responsible for validating members’ Out-of-Pocket Maximum (OOPM) cost shares based on the audit years provided in the Accumulator Overages Report. The process involves reviewing the members’ responsibilities according to their plan benefits and ensuring that OOPM limits and any overages are accurate, following the preset criteria established. If a member has exceeded their OOPM limit, the excess amount will be reimbursed directly through medical claims and pharmacy reimbursements.

1-3 Years of experience in claims processing
Good logical thinking ability
Knowledge of US Healthcare Industry
Should have exposure to MS Office

RESPONSIBILITY:

Adjudication/Adjustments of claims with zero errors
Completion of claims in queue within specified time frame

About the Company

Reqroute is a Staffing and Recruitment Marketing firm based in the heart of Silicon Valley in California. We enable our clients to concentrate on their core business while we look after their recruitment and staffing needs. We are a young, vibrant and dynamic organization that offers a wide range of services for the entire employment cycle. Reqroute leverages social media networks to build a Social Media Recruiting Strategy (SMRS) for your organization to help you reach the passive candidate pool and also provide services in... Know more