Employer Industry: Health Insurance

Why consider this job opportunity:
- Salary up to $93,030
- Comprehensive health benefits (Medical/Dental/Vision)
- Generous PTO and Paid Volunteer Time Off
- Retirement Plans and Tuition Reimbursement
- Incentive Plans and Wellness Programs
- Opportunity to work in a collaborative environment with a focus on accurate clinical determination

What to Expect (Job Responsibilities):
- Review professional medical claims policy-related issues or claims in pending status
- Make determinations based on clinical reviews, along with federal, state, and company guidelines
- Prepare cases for external and internal review
- Provide timely and accurate responses to inquiries from the Claim Policy teams
- Collaborate with claims policy analysts to ensure accurate claims adjudication

What is Required (Qualifications):
- High School Diploma or GED required; prefers a BSN and a NJ State Registered Nurse License or MD (including non-board certified but certified abroad)
- Minimum of 3 years clinical experience preferred
- Minimum of 3 years business/insurance experience preferred
- Strong knowledge of Microsoft Office Products required
- Team player with strong analytical, written, verbal communication, and interpersonal skills

How to Stand Out (Preferred Qualifications):
- Certification in medical coding preferred
- Knowledge of Horizon product lines preferred
- Familiarity with Workman's Compensation, Medicare, COB, and no-fault preferred

#HealthInsurance #ClinicalReview #InsuranceJobs #CareerGrowth #HealthBenefits

We prioritize candidate privacy and champion equal-opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter any employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top-tier employer.