Claims Processor I

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

📋 Description

• Conduct research and verify intricate claims information to ensure accurate and timely processing of claims.

• Input coded and necessary details into claims systems.

• Review and amend scanned claims documents as needed.

• Verify claims for completeness and precision prior to final submission.

• Detect and address discrepancies while requesting any missing information.

• Ensure that contract benefits are applied accurately.

• Investigate procedural inquiries utilizing supporting documentation and training manuals.

• Recognize incomplete adjudication guidelines and propose updates to procedures.

• Identify training needs and consult with management when necessary.

• Document daily production metrics, including edits processed, hours worked, downtime, and special projects.

• Reject, redirect, or return claims that are incomplete or inaccurate.

• Maintain communication with internal departments, staff, providers, members, lawyers, insurers, and other external entities.

• Execute other job-related responsibilities within the designated scope.

⛳️ Requirements

• High School Diploma or equivalent is mandatory.

• An Associate's degree is preferred.

• At least 1 year of relevant clerical or data entry experience is required.

• A diploma in medical office or medical coding can substitute for one year of experience.

• Completion of the Medical Assistant, Coding & Insurance Pathway from BRCC can also substitute for one year of experience.

• Experience in claims processing or claims coding is preferred.

• Ability to enter data at a speed of 4000 keystrokes per hour is essential.

• Medical coding training is preferred.

• Must exhibit critical thinking and problem-solving capabilities.

• Familiarity with medical and health insurance terminology is preferred.

• Proven verbal and written communication skills are required.

• Must demonstrate proficiency in PC skills, including Microsoft Office (Word, Excel, Outlook, etc.).

• No licenses or certifications are necessary.

• Residency in or a willingness to relocate to Louisiana is preferred for all positions.

• Must successfully pass background and pre-employment drug screening; employment restrictions apply to specific felony convictions related to dishonesty or breach of trust.

🏝️ Benefits

• Access to employee resources that promote well-being, health, ongoing education, skill development, professional growth, and community service.

• Company properties are smoke- and tobacco-free.

• Reasonable accommodations are available for individuals with disabilities.

• Pre-employment drug screening and background checks will be conducted following a job offer.