The Claims Examiner is responsible for accurately adjudicating medical claims and processing adjustments in compliance with plan documents and industry regulations. Key duties include resolving appeals, managing inventory to meet production goals, and responding to internal and external inquiries.
Point C
11 Remote Job Openings at Point C
Lead the end-to-end configuration, administration, and optimization of the Zendesk platform across the enterprise. Partner with business teams to translate operational needs into platform enhancements and manage the system roadmap.
Design and develop enterprise Power BI reports and dashboards to drive insights across healthcare operations and finance. Manage the Power BI environment, including administration, governance, and performance optimization.
Lead all claims funding and check run operations, managing the end-to-end process from register generation to custodial account reconciliation. Oversee a team of funding specialists and drive the implementation of check run automation within the VBA platform.
Serve as the primary point of contact for employer groups and brokers to manage benefits administration, eligibility, and billing. Coordinate with internal departments to resolve escalated claims issues and maintain strong client relationships.
Support Account Managers in maintaining broker and client relationships through professional communication and deliverable preparation. Utilize AI tools to accelerate research on industry trends and refine client-facing documentation.
Analyze healthcare and clinical datasets using AI tools to identify trends and improve utilization management processes. Build data tools and dashboards to provide actionable insights for clinical and operational leadership.
Develop and maintain healthcare plan designs and benefit configurations to optimize auto adjudication processes. Collaborate with IT and stakeholders to integrate systems, perform comprehensive testing, and ensure regulatory compliance.
Manage and retain a portfolio of key client accounts valued between $5-$8 million while serving as a trusted advisor to plan sponsors and brokers. Oversee the entire client lifecycle from onboarding to renewal, ensuring high satisfaction and alignment with strategic goals.
Support the Northeast Regional Sales Director in executing strategies to achieve new business and revenue targets. Build and maintain strong relationships with benefit consultants and brokers while managing the sales pipeline in Salesforce.
The Customer Service Agent provides benefit information, claim status, and general health plan information to callers. They engage with customers to create a welcoming experience and ensure accurate responses to inquiries.
