Claims Processor

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

📋 Description

• Screen, assess, and evaluate online submissions, rectify errors, and conduct quality control reviews along with the final adjudication of both paper and electronic claims.

• Make determinations on whether to return, reject, or approve claims in accordance with the organization's policies and procedures.

• Analyze processed claims and inquiries to identify necessary corrective actions, including adjustments to claims as required.

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

• Coordinate benefits and engage with customers as necessary.

• Execute claims adjustments resulting from audits, calls from members/providers, information from other insurance entities, appeals, and any system modifications.

• Offer technical support in the research and resolution of inquiries.

• Receive and manage claims by inputting and verifying claims data.

• Address claim edits, review historical records, assess benefit eligibility, and establish final payment amounts.

• Escalate issues to supervisory staff and ensure professional communication with both internal and external stakeholders.

• Achieve production and quality benchmarks while ensuring timely and accurate completion of tasks.

• Keep precise records, including timekeeping records, and participate in mandatory training sessions.

⛳️ Requirements

• High School Diploma or GED.

• At least 1 year of relevant experience.

• Capability to follow directions and navigate through multiple systems concurrently.

• Understanding of administrative and clerical processes and systems, including word processing and the management of files and records.

• Proficiency in applying mathematical concepts to adjudicate claims.

• Ability to address problems following established methods and guidelines.

• Familiarity with operating systems specific to claim processing.

• Competence in reviewing claims and analyzing critical data.

• Availability during standard Eastern Time business hours.

🏝️ Benefits

• Comprehensive health care coverage.

• Retirement savings plans.

• Opportunities for professional development and training.

• Flexible work schedules.

• Employee wellness programs.