Claims Processor – COB

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

📋 Description

• Conduct manual reviews, evaluations, and processing of healthcare claims within the Facets platform.

• Investigate and resolve intricate claim situations involving benefits, plan provisions, payment regulations, and necessary documentation.

• Handle Coordination of Benefits (COB) and/or ITS Home/Host claims.

• Confirm primary and secondary payer responsibilities.

• Detect claim discrepancies and establish suitable resolutions.

• Accurately document decisions made during the claim-processing phase.

• Implement established policies, procedures, and specific client requirements.

• Achieve quality and productivity targets consistently.

• Raise claims issues, system-related concerns, or processing trends when further review is necessary.

• Work collaboratively with team members and client stakeholders to ensure timely and precise resolution of claims.

⛳️ Requirements

• Active and practical experience as a Facets Claims Examiner.

• Advanced understanding of Facets claims processing (not Configuration).

• Proven experience in manually processing healthcare claims, including complex and exception-based cases.

• Current experience in manually processing Coordination of Benefits (COB) or ITS Home/Host claims.

• Capability to analyze claim details, benefit information, and supporting documents.

• Strong attention to detail and critical thinking abilities.

• Dedication to maintaining quality standards.

• Ability to thrive in a production-focused, deadline-driven environment.

• Excellent written and verbal communication skills.

• Must be a U.S. Citizen.

• Must be available for a W2 hourly contract; H-1B, C2C, and 1099 candidates will not be considered.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• 401(k) plan with a generous employer match.

• Employee stock purchase plan.

• Paid Time Off.

• Paid parental leave.

• Adoption assistance.

• Wellness Program featuring free annual health screenings and coaching.

• Bank at work.

• On-site workshops.

• Continuous programs acknowledging significant employee life events.