Offer summary

Qualifications:

High School Diploma or GED required., 1-3 years of experience in claims processing, billing, or medical terminology preferred., Demonstrated analytical skills and reading comprehension abilities., Basic written and oral communication skills, along with computer navigation skills..

Key responsibilities:

Examine and resolve non-adjudicated claims based on contracts and policies.

Process claims to ensure timely payments and resolve pending issues.

Collaborate with the Quality team for clarity on procedures and receive coaching.

Complete daily productivity data for performance statistics and collaborate with multiple departments.

Job description

Job Description:

60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures.
Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims.
The Claims Processor also uses automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
25% Completes research of procedures.
Applies training materials, correspondence and medical policies to ensure claims are processed accurately.
Partners with the Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership.
Required participation in ongoing developmental training to perform daily functions.
10% Completes productivity daily data that is used by leadership to compile performance statistics.
Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
The requirements listed below are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.