Claims Processor

This is a fully remote position, open to applicants in Alabama, +45 more states.

📋 Description

• Screen, assess, and evaluate online submissions, correct mistakes, and conduct quality control reviews and final adjudication of both paper and electronic claims.

• Decide whether to return, reject, or approve claims in accordance with organizational policies and procedures.

• Analyze processed claims and inquiries to identify necessary corrective actions, including making adjustments to claims when needed.

• Utilize enrollment, benefits, and historical claim processing data to implement corrective measures.

• Coordinate benefits and engage with customers as required.

• Accurately and promptly complete claims adjustments in response to audits, member/provider inquiries, other insurance information, appeals, and system modifications.

• Offer technical support in researching and resolving inquiries.

• Receive and process claims by entering and verifying claims data.

• Resolve claim edits, review historical records, ascertain benefit eligibility, and evaluate payment levels for final payment determinations.

• Appropriately escalate issues while maintaining professional communication with both internal and external stakeholders.

• Achieve production and quality benchmarks, keep precise records and timekeeping, and attend mandatory training sessions.

⛳️ Requirements

• High School Diploma or GED.

• Excellent verbal and written communication abilities.

• Capability to follow instructions and navigate multiple systems concurrently.

• Familiarity with administrative and clerical processes and systems, including word processing and file management.

• Proficiency in using mathematics for claims adjudication.

• Ability to resolve issues within established methods and guidelines.

• Knowledge of operating systems specific to claims processing.

• Competence in reviewing claims and analyzing critical data.

• Ability to read benefits, investigate edits, and make benefit determinations as necessary for adjusting and adjudicating a wide range of claims.

• A minimum of 1 year of experience in claim billing or processing is preferred.

🏝️ Benefits

• Competitive salary and comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive work environment promoting work-life balance.