Job Details

Job Description:

Pay Range: $17.34hr - $21.34hr

• The Claims Processor is responsible for examining, researching, and resolving non-adjudicated claims to ensure accurate and timely processing in accordance with medical policies, contracts, and procedures.
• The role involves working across multiple systems, collaborating with internal teams, and maintaining productivity and quality standards.

• Examine and resolve non-adjudicated claims by identifying processing requirements based on contracts, medical policies, and procedures.
• Process product- or system-specific claims to ensure timely payment generation.
• Calculate deductibles and maximums and research and resolve pending claims.
• Utilize automated systems to pend claims for accurate completion in alignment with medical policy and contractual requirements.
• Research procedures and apply training materials, correspondence, and medical policies to ensure accurate claim processing.
• Partner with the Quality team for clarification on complex or difficult claims and receive coaching from leadership.
• Participate in ongoing developmental training to support daily functions.
• Complete daily productivity reporting used by leadership for performance tracking, workflow design, and planning.
• Collaborate with multiple departments to provide feedback, resolve issues, and answer basic processing questions.

• High School Diploma or GED.

• Less than one year of experience processing claim documents.

• Experience in claims processing, billing, or medical terminology.

• Demonstrated analytical skills.
• Strong reading comprehension and ability to follow written directions.
• Basic written and oral communication skills.
• Proficiency in navigating computer applications.

• High School Diploma or GED required.