CHW Claims Representative / Medical Biller

Claims Representative at 20/20 Vision Youth responsible for managing, evaluating, and processing claims related to services, programs, incidents, or benefits associated with youth participants, staff, and organizational operations.

This role serves as a liaison between families, insurance providers, internal departments, and external agencies to ensure claims are handled accurately, ethically, and in compliance with legal, insurance, and internal policy requirements.

Key responsibilities

• Verify documentation completeness and ensure all required forms are submitted.
• Determine claim eligibility based on organizational policies and insurance coverage.
• Gather statements, review case notes, interview involved parties, and assess program records as needed.
• Maintain accurate, secure, and compliant claim documentation in internal systems.
• Identify inconsistencies or missing information and follow up accordingly.
• Submit claims to insurance carriers or internal review committees.
• Calculate claim values when applicable, including reimbursements, service credits, or damages.
• Monitor claim progress and ensure timely resolution.
• Provide claim status updates and explain processes clearly.
• Collaborate with program managers, HR, finance, and legal teams.
• Ensure claims follow state laws, insurance requirements, and internal risk-management policies.
• Identify claim trends to support safety practices, policies, and staff training.
• Support audits, reporting, and data tracking for compliance and funding requirements.
• Help resolve conflicts, clarify misunderstandings, and advocate for consistent tracking.