Medical Claims Representative - Onsite/hybrid positions

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.

Key requirements:

• Self-starter with the ability to work with integrity and independently to achieve desired results.
• Clinical background or medical terminology knowledge helpful but not necessary.
• Demonstrated proficiency in Microsoft Outlook and Excel with 30 WPM typing skills.
• Strong organizational skills and multitasking ability.
• Excellent telephone skills required.
• Good cognitive reasoning ability.
• Detailed and thorough work orientation.
• Minimum 1-2 years of experience in a consumer service organization or healthcare environment.

Education/Experience

• High School Diploma or GED Equivalent

About Edwards Health Care Services, Inc.

Edwards Health Care Services, Inc. (EHCS) is a national direct-to home medical supply provider of high quality medical and diabetes products that support the needs of individuals with diabetes and other conditions. For over 25 years, EHCS have been lighting the way to better health by providing customers an easier way to have products delivered directly to their door. By partnering with healthcare professionals, product manufacturers, and a large network of government and private insurers, EHCS prides itself on personalized customer service and a simplified, seamless order process for every customer…every time! For more information, visit www.myehcs.com.

About GEMCORE

GEMCORE, a family of companies headquartered in Hudson, Ohio - Edwards Health Care Services, GEMCO Medical, GemCare Wellness, and GEM Edwards Pharmacy - offers a core set of healthcare solutions by partnering with manufacturers, providers, employer groups, insurance groups, and patients to deliver high quality healthcare products and innovative services to proactively better lives. For more information, visit www.gemcorehealth.com.