Join the frontlines of today's healthcare transformation at VillageMD as a Claims Specialist (Remote)!

Why VillageMD?

At VillageMD, we're looking for a Claims Specialist to help us transform the way primary care is delivered and how patients are served. As a national leader on the forefront of healthcare, we've partnered with many of today's best primary care physicians. We're equipping them with the latest digital tools. Empowering them with proven strategies and support. Inspiring them with better practices and consistent results.

We're creating care that's more accessible. Effective. Efficient. With solutions that are value-based, physician-driven and patient-centered. To accomplish this, we're looking for individuals who share our sense of excellence, are ready to embrace change, and never settle for the status quo. Individuals who have the confidence to lead but the humility to never stop learning.

Could this be you?

As an integral member of the VillageMD, the Claims Specialist will partner with our VillageMD Operations to ensure provider demographics and contract details are entered into the payment system, EZ-Cap.

How you can make a difference

• Process claims that pend for various hold reasons to assist in the final determination on claim disposition
• Process adjustments related to projects or provider disputes providing timely follow-up provider call backs
• Acts as Claims Department subject matter expert on departmental and corporate projects
• Support business definition and testing efforts, attends project meetings, maintains project plans and provides internal and external status reports
• Work with management and associates to document current business and workflow processes and collaborates in identifying, defining, and documenting process improvement options and alternatives
• Research complex claims issues and works with other departments to resolve.
• Serve as primary liaison to all external departments, markets, and providers on claims related content
• Analyze and trend claims issues, performs true root cause analysis, and determines next steps for resolution and process improvement
• Research issues, compiles feedback and drafts corresponding business requirements documents and business decision documents as needed
• Communicate changes in processes, project status and issue resolutions through email, memos, group presentations, and/or individual one-off meetings
• Perform special projects as assigned

Skills for success

• A high level of personal accountability and ability to work independently
• Bias for action with a solution-oriented approach
• The ability to be flexible in an ambiguous and dynamic environment
• Strong communication skills
• Superior relationship and interpersonal skills with the ability to craft meaningful relationships across diverse stakeholder groups
• Proven leadership competency including the ability to motivate and develop teams and achieve results
• Experience in conflict management and problem resolution
• A low ego and humility; an ability to gain trust through good communication and doing what you say you will do

Experience to drive change

• 5+ years of experience in claims processing Medicare and commercial claims
• 3+ years of knowledge and experience in researching and resolving operational issues
• EZ-Cap experience preferred

How you will thrive

In addition to competitive salaries, a 401k program with company match and a valuable health benefits package, VillageMD offers paid parental leave, pre-tax savings on commuter expenses, and generous paid time off. You work in a highly-collaborative, conscientious, forward-thinking environment that welcomes your experience and enables you to make a significant impact from Day 1.

Most importantly, you make a difference. You see a clear connection between your daily work on VillageMD products and services and the advancement of innovative solutions and improved quality of healthcare for providers and patients.

Our unique VillageMD culture – how inclusion and diversity make the difference

At VillageMD, we see diversity and inclusion as a source of strength in transforming healthcare. We believe building trust and innovation are best achieved through diverse perspectives. To us, acceptance and respect are rooted in an understanding that people do not experience things in the same way, including our healthcare system. Individuals seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Those seeking employment at VillageMD are considered without regard to race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

For Colorado Residents only: The base compensation range for this role is $20.00 to $27.00. At VillageMD, compensation is based on several factors including but not limited to education, work experience, certifications, location, etc. This role may be eligible for annual/quarterly bonus incentives (if applicable), and the selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan with company match.

Explore your future with VillageMD today.