Medical Claims Representative - Onsite/hybrid positions - GEMCORE

GEMCORE’s continued success has earned us national recognition with Inc. Magazine’s list of America’s Fastest-Growing Companies and with the Cleveland Plain Dealer as a 2020, 2021, 2023, and 2024 Top Workplace! GEMCORE is a rapidly growing multi-state family of companies headquartered in Hudson, OH.

Are you looking to begin or further your career in the medical supply industry where you are able to contribute to the success of the business, and build lasting relationships? All while allowing for personal time every evening, weekend, and holiday? Edwards Health Care Services (EHCS), a division of GEMCORE, is a well-established and growing national direct-to home medical supply provider. We are seeking a highly motivated Medical Claims Representative to join our high energy team. The Medical Claims Representative's primary role is to determine the root cause of denials and payment delays.

• We are a fast-growing company with advancement opportunities!
• This position offers the ability to work unique problems and to apply complex problem solving skills.
• This is a full-time, non-exempt, position.
• Once training is complete, this position will potentially be part of a hybrid remote work schedule. This position is located in Hudson, OH.
• Schedule is 8:00 am - 4:45 pm, Monday through Friday.
• Employer paid vacation.
• Benefits available include medical/dental/vision, life, short and long-term disability insurances, and 401K Retirement Savings Plan.

Key Responsibilities

• Analyze reports on insurance payment differences, appeals and rebills.
• Work claim denials.
• Identify denial trends and suggest process improvements.
• Collaborate with claims team and communicate effectively with all other department managers in solving issues and implementing new procedures.
• Proficient in the knowledge of healthcare products, deductibles, co-payments and third-party reimbursement for customer education and employee training purposes.