Claims Processor

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct thorough reviews of medical claims to confirm all information is complete and accurate.

• Utilize various computer systems and platforms to accurately research and process assigned claims (e.g., checking pricing and prior authorizations).

• Implement the appropriate benefits for each claim based on claims processing policies, including grievance procedures, state regulations, CMS guidelines, and benefit plan documents.

• Evaluate documentation to determine the necessity of the visit and whether the treatment received is covered by the policy.

• Decide on the approval or denial of claims, and draft denial letters as necessary.

⛳️ Requirements

• At least one year of recent experience in processing medical claims for a health insurance company or payer.

• Knowledge of medical claim forms, specifically CMS-1500 and UB-04.

• Proficient understanding of coding systems, including ICD-10, HCPCS, and CPT.

• Strong skills in computer navigation and technology, including Microsoft Windows, Excel (advanced functions), and online tools and platforms.

• Outstanding verbal and written communication abilities.

• Capacity to maintain focus and productivity in a high-volume, repetitive task setting.

• High School Diploma or equivalent.

🏝️ Benefits

• Medical, Dental, and Vision coverage.

• Life Insurance.

• Short-Term and Long-Term Disability options.

• Flexible Spending Account (FSA).

• Employee Assistance Program.

• 401(k) with employer contribution.

• Paid Time Off (PTO).

• Tuition Reimbursement.