Sr Reconciliation Representative

@ American Specialty Health

Sr Reconciliation Representative at American Specialty Health

American Specialty Health Incorporated is seeking a Sr Reconciliation Representative to join our Reconciliation department. This remote role involves reconciling claims, including complex claims, for payment as per Explanation of Benefits from Health Plan Payors for 2-step accounts.

Remote Worker Considerations

Candidates will be trained remotely and must have a designated work area at home with company-provided technology equipment. A stable internet connection (minimum 50 Mbps download and 10 Mbps upload) is required to participate in online meetings.

Responsibilities

• Reconcile, resolve, and research 2-step claims and payments.
• Manually reconcile claims from paper EOBs and spreadsheets.
• Communicate with Health Plans regarding claim statuses.
• Use Health Plan and TPA websites for claims verification.
• Review various reports to reconcile claims.
• Notify supervisors of trends related to invalid denials.
• Document comments in internal systems and spreadsheets.
• Review and respond to ASHCore logs within 48 hours.
• Meet department production and quality standards.
• Maintain confidentiality of all claims data.
• Attend organizational and departmental meetings and trainings.
• Assist and collaborate with Claims Department staff on routine duties and special projects.

Qualifications

• High School diploma or GED required.
• 2-3 years of claims processing experience preferred.
• Computer, typing, 10-key, and telephone skills are needed.
• Knowledge of Microsoft Word and Excel is a plus.
• Familiarity with Managed Care, HMO, and PPO health plans.
• Strong interpersonal and customer service skills.

Core Competencies

• Positive, respectful interpersonal interactions.
• Excellent customer service for internal and external stakeholders.
• Effective organization, prioritization, and multitasking skills.
• Demonstrated accuracy and productivity in a dynamic environment.
• Strong problem analysis and solution development.
• Strict confidentiality in all matters.

Mobility, Physical & Environmental Requirements

This is a primarily sedentary work-from-home role. Candidates must be able to sit for long periods, communicate effectively, and occasionally travel within the facility if required.

Equal Employment Opportunity

American Specialty Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without discrimination.

Key skills/competency

Reconciliation, Claims, Remote, Health, Processing, Analysis, Attention, Confidentiality, Communication, Customer Service