Senior Complex Claims Specialist managing high - severity professional liability claims for Hiscox. Collaborating with business leaders and providing technical support in a hybrid role.
About the role
- Medicaid Claims Analyst responsible for validating and remitting payments for Medicaid Drug Rebate processes. Ensuring compliance with CMS guidelines and Teva rebate contract terms.
Responsibilities
- Work with assigned states to get Medicaid Summary invoice, summary data file and Claim Level Invoice each quarter and review to ensure completeness of information received.
- Upload data into Medicaid systems and authorize transactions.
- Document errors and perform research.
- Conduct initial quality check on summary data on all claim submissions to ensure rebate eligibility and data consistency.
- Perform Claim Level Detail validation.
- Review suspect claim records and determines if record should be disputed for payment.
- Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims.
- Complete Medicaid analyzes and documentation on assigned states/programs. Communicate to manager for key findings and changes to state programs.
Requirements
- Education Required: High School Diploma required. Bachelor’s degree preferred.
- Experience Required: Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company, state and/or state agency or as Medicaid consultant or equivalent work experience.
- Experience Preferred: Minimum of 2+ years pharmaceutical/product focused healthcare experience; Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution.
- Specialized or Technical Knowledge, License, Certifications needed: Knowledge of the Model N or Revitas/Flex Medicaid and/or Flex Validata system (or other comparable system) and advance Microsoft Excel skills.
- Familiar with CMS Medicaid rules and state specific issues.
- Up to date knowledge on Medicaid Validation rules and issues with 340B covered entities.
- Strong ability to organize and manipulate large volume of data in various formats. Attention to detail and high degree of accuracy in data processing and reviews.
Benefits
- Comprehensive Health Insurance: Medical, Dental, Vision, and Prescription coverage starting on the first day of employment, providing the employee enrolls.
- Retirement Savings: 401(k) with employer match, up to 6% and an annual 3.75% Defined Contribution to the 401k plan.
- Time Off: Paid Time Off including vacation, sick/safe time, caretaker time and holidays.
- Life and Disability Protection: Company paid Life and Disability insurance.
- The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Job title
Job type
Experience level
Salary
Degree requirement
Location requirements
Claims Adjuster responsible for managing US Casualty and Property reinsurance claims. Working collaboratively with internal and external stakeholders in a remote role with occasional office travel.
Claims Coordinator providing operational support for processing incident reports and insurance claims. Serving as a liaison between operations, insurance carriers, and stakeholders to ensure compliance and accurate documentation.
Field Claims Representative managing insurance claims in assigned Indiana counties for Auto - Owners. Requires field claims handling experience and familiarity with property claims and legalities.
Analyzing and processing complex workers' compensation claims for Sedgwick, a global industry leader. Delivering customer - facing solutions in a caring culture with professional development opportunities.
Workers Compensation Claims Examiner adjudicating complex customer claims for global industry leader. Analyzing claims, negotiating settlements, and communicating with clients in a dynamic environment.
Workers Compensation Claims Examiner analyzing claims for clients at Sedgwick, a global leader in risk and claims administration. Ensuring benefit determination and claims processing adhere to industry standards and client expectations.
Auto Claims Specialist at Cox Automotive resolving customer claims and facilitating vehicle arbitration. Managing the arbitration process, inspecting post - sale transactions, and ensuring adherence to policies.
Senior Error & Omissions Claims Specialist investigating and resolving E&O and EPLI claims for Utica National Insurance Group. Requires strong claims handling acumen with multi - state experience.
Senior Error & Omissions Claims Specialist responsible for handling E&O and EPLI claims. Working on a multistate basis with direct handling and negotiation responsibilities.