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USA Cares

Payment Integrity Validation Specialist

Would you like to join a company that is a leader in the health insurance industry?  The Rawlings Group has successfully provided cost containment services to the largest health insurance plans in the country for more than 40 years.

Would you like to join a newly formed team utilizing state-of-the-art proprietary technology to ensure that medical and pharmacy claims payments are made properly?  The Payment Integrity Validation team has been created to support the workflows and information gathering processes of coordination of health insurance benefits for our clients.

Would you like to learn technical and communication skills to progress within a growing organization?  The experience in the Validation Specialist team could ultimately prepare you for an analyst or management role with earnings potential of $100,000+ in two to three years.

We provide excellent classroom training in a supportive environment to provide you with the skills and tools necessary to be successful. We are looking for hard-working, talented people who share our commitment to excellence.  Our comprehensive benefit package includes health and dental benefits, short disability insurance, 401(k) Plan with company contribution, paid time off and more. We also offer an onsite gym, cafe and coffee shop.

Our Culture is focused on:

  • The guiding principle of doing the right thing.
  • Caring for our employees and taking pride in the work they do.
  • Providing recognition and financially rewarding employees for their success.

Our Values are:

  • Integrity and Trust
  • Customer Service Excellence
  • Innovation
  • Diversity and Inclusion
  • Honoring our Veterans and Their Service 

Job Summary

The Validation Specialist confirms that insurance information of health insurance members, is accurate to facilitate the coordination of benefits for healthcare claim payments.  Validation Specialists utilize access to online insurance eligibility and claims payment platforms and conduct outreach to ensure accuracy of data. This role builds a foundation of knowledge that supports future advancement.

Responsibilities

  • Verifies medical insurance eligibility data.
  • Accurately documents data gathered.
  • Follows specific timeframes to complete tasks.
  • Uses multiple computer systems in order to work efficiently.
  • Provides excellent customer service. 

Qualifications

  • Associate’s Degree or equivalent combination of experience in health insurance or related fields, which would provide the necessary knowledge, skills and abilities to successfully perform the work.
  • Good oral and written communication skills, including excellent phone communication skills, are required.
  • Ability to work well independently or in a team environment.
  • Very strong attention to detail and organizational skills.
  • Experience in the healthcare field is helpful, but not required. 
  • Word and Excel proficiency required.

Physical Requirements

  • Frequently remains in sitting position for long periods of time to perform duties
  • Frequently concentrates for long periods of time, paying close attention to detail
  • Frequently uses and views the computer using fingers, hands, and vision
  • Frequently works in a well-lit, tempered environment
  • Occasionally moves through office to communicate with other employees


*Equal Employment Opportunity.  It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification.
*The Rawlings Group is an employment at will employer.

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