Claims Processor I

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

📋 Description

• Conduct research and process claims in accordance with business regulations, internal standards, and processing guidelines.

• Validate procedure and diagnosis coding.

• Address system edits, audits, and claims errors by utilizing research, approved references, and investigative resources.

• Collaborate with internal departments to manage edits and deferrals.

• Update patient identification, health insurance details, provider identification, and other necessary files.

• Execute additional responsibilities and special projects as needed.

• Uphold confidentiality, information security, productivity, safe equipment usage, and adherence to remote work and contract protocols.

⛳️ Requirements

• High School Diploma or equivalent qualification.

• Must possess authorization to work in the U.S.

• Must successfully complete all mandatory pre-employment screenings, including a drug test.

• Capability to obtain and maintain necessary access approvals, credentials, background clearances, or system access relevant to the assigned contract.

• One (1) year of experience in a healthcare or insurance setting (preferred).

• Ability to perform complex mathematical calculations (preferred).

• Proficiency in word processing and spreadsheet software (preferred).

• Familiarity with database applications (preferred).

• Strong analytical and organizational abilities.

• Excellent customer service skills.

• Strong verbal and written communication skills.

• Proficient spelling, punctuation, and grammar abilities.

• Good judgment skills.

• Basic business math skills.

• Ability to operate standard office equipment.

• Capability to fulfill established essential functions and physical requirements, with or without reasonable accommodation.

🏝️ Benefits

• Free medical insurance provided for employees, with an optional buy-up plan available.

• Medical opt-out plan offered for eligible employees.

• Paid holidays and sick leave.

• Paid vacation available after one year of employment based on hours worked.

• Eligibility for the 401(k) plan for both full-time and part-time employees from their first day of employment.

• Supplemental benefits available, including Accident, Critical Illness, Short Term Disability, and Hospital insurance.

• Employee Assistance Program.

• Opportunities for occasional in-person training, meetings, or other activities required by the contract.