Urgent | Phrn (Associate - Accidental Claims) | Hybrid

Work schedule: Nightshift (starts anytime between 9:00 pm and 12:00 pm) Weekends off
Work set-up: Onsite Training (2-3 months) then possibility of a hybrid setup (conditions apply) Requirements:  Bachelors degree in nursing. PHRN is required1 to 2 years of experience on a similar role, preferably in a fast-paced environment is preferred but not necessaryAbility to navigate and use Excel, and other Microsoft products.Excellent attention to detail, with a strong ability to spot errors and inconsistencies in data.Exceptional organizational skills and the ability to multitask effectively.Strong verbal and written communication skills.Job Responsibilities: Accidental Claims are worked to a stopping point when pulled and follow 10-day letter process when appropriate.Maintain new info and pend tasks within 2-days and all other tasks within 3-days.Work tasks to completion and not moving tasks without appropriate work completed.Complete timely and thorough claim notes/phone interviews and uploading of all claim documents/MD Guidelines.Act on direction provided by your leader and/or Technical Partners. This includes 1x1 conversations, feedback provided in Quality Reviews, Pend Reviews, RN Consults.Aggressively manage past due claims while completing timely pend reviews as outlined in the Performance Expectations. If a decision is not able to be made within the latter of 30 days from Mail Received Date, or Accrual date, a decision should be made by day 30.Manage BBDA volume of 25% based on total approved claims.