Careers

We are seeking a full-time, entry-level candidate to join our business analytics team. The department specializes in data reconciliation, data analysis, and reporting. The position plays a versatile role in supporting the finance, accounting, and claims operations departments, as well as collaborating with IT to deliver business-enhancement projects.

Responsibilities & Expectations

Primary Responsibilities

• Reconcile, for each set of health insurance plans, patient membership data and dollar-receipts-per-member
• Calculate monthly dollars-paid-per-member payments to physicians
• Assist the accounting department with weekly claims payment processing
• Audit monthly claims (to-be-paid and paid) to physicians
• Prepare and convert monthly financial and operational data into profitability and efficiency reports for the executive team

We Expect Candidates to Be

• Analytical and logical
• Data-driven
• Interested in the healthcare industry
• Clear and concise with all forms of business communications
• Organized in thought and the workspace

Qualifications

Required Qualifications

• Bachelor of science in finance, accounting, or management information systems
• Proficient in Microsoft Office Suite, especially Excel

Preferred Qualifications

• Related work experience
• Microsoft SQL querying
• Report writing: Crystal Reports, PowerBI, Cognos, QlikView, Tableau, SSRS, or comparable business intelligence reporting tools

Location

Doral, Florida

Schedule

Monday – Friday, 8 am – 5 pm

We are seeking a full-time customer service representative to join our support services team. We are looking for a candidate who exhibits a pleasant attitude and willingness to help others. These traits are essential in assisting our customers in a friendly and respectful manner. In addition to people skills, we encourage our representatives to be goal-oriented and express a desire to learn new tools and skill sets. Ideal candidates are positive, energetic, enthusiastic, and computer-savvy.

Responsibilities & Expectations

• Direct communication with members, providers, and health plans
• Confirmation of benefits and eligibility information to members, providers, and health plans
• Provide confirmation of participating providers in the network
• Provide claim status to members, clients, and providers
• Resolve problems by identifying the customer’s complaint, selecting and explaining the best resolution for the issue, and escalating to upper management when necessary
• Keep managers informed of any issues that may require their attention in order to avoid or resolve an existing problem
• Apply knowledge, experience, common sense, and critical thinking to all issues being dealt with
• Ability to multitask and prioritize
• Respond to general inquiries from members and providers (plan benefits, limits, co-pays, deductibles, policy procedures, reimbursements, etc.); redirect callers when necessary
• Follow up until completion on all issues that are not resolved on the initial contact; keep parties updated on actions taken and next steps
• Service the maximum number of callers in the quickest and most efficient way without sacrificing the quality of the service

Qualifications

Required Qualifications

• 1+ years customer service experience in healthcare or related experience
• High school diploma or equivalent certification
• Excellent communication skills
• Ability to multitask, prioritize, and manage effectively
• Must be computer literate and able to quickly navigate in a windows PC environment
• Must have a “can do” attitude
• Must be organized, assertive, and patient

Preferred Qualifications

• Experience with optometry, ophthalmology, and/or podiatry specialties
• Bilingual (English and Spanish) preferred

Location

Doral, Florida

Schedule

Monday – Friday, 8:15 am – 5 pm

We are seeking a medical claims processor to join our team. The candidate will play an active role within claims operations to assure timely and accurate administration of claims processing, in compliance with state and federal regulations, as well as other applicable rules and requirements outlined by internal and external policies and procedures.

Responsibilities & Expectations

• Review claims and corresponding edits to determine the appropriate handling of payments and denials
• Review formal written appeals from providers, and send written responses of decisions within required timelines
• Investigate claims issues by performing research and gathering information to determine the root cause of the problem
• Communicate and collaborate with impacted departments to resolve claims issues
• Perform other duties assigned by supervisor, and assist on requests from compliance department as needed
• Address inquiries from providers
• Maintain a full comprehensive understanding of claims policies and procedures by studying appropriate reference materials, including covered benefits, coding, and reimbursement policies and contracts; participate in ongoing training as needed

Qualifications

Required Qualifications

• High school diploma, GED, or equivalent required
• At least 3 years of healthcare administration and/or managed care experience
• At least 3 years of claims experience that demonstrates progressive growth within claims operations
• Strong understanding of health plan terminology
• Computer literate and proficiency in Microsoft Office

Preferred Qualifications

• Extensive knowledge of claims policies and procedures, including industry standards from Medicaid, CMS, and CCI Edits.

Location

Doral, Florida

Schedule

Monday – Friday, 8:15 am – 5 pm