Offer summary

Qualifications:

High School Diploma or GED required., More than three years of experience processing claim documents., 5+ years of claims processing, billing, or medical terminology experience., Demonstrated analytical skills and proficiency in computer applications..

Key responsibilities:

Review and adjudicate paper/electronic claims under direct supervision.

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

Complete daily productivity data for performance statistics and reporting.

Collaborate with multiple departments to provide feedback and resolve processing issues.

Job description

Our Client, a Health Insurance company, is looking for a Processor, Claims I for their Remote location.

Responsibilities:

Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.
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 use 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 Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing 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.

Requirements:

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.
High School Diploma or GED
More than three years experience processing claim documents. Experience with processing Inter-Plan Teleprocessing System (ITS) Claims.
5+ years Claims processing, billing, or medical terminology experience
Demonstrated analytical skills, Proficient
Demonstrated reading comprehension and ability to follow directions provided, Proficient
Basic written/oral communication skills , Proficient
Demonstrated ability to navigate computer applications , Proficient
The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.

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