Claims Processor II

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

📋 Description

• Accurately and promptly process all claims in line with claims payment policies and contractual agreements with customers/providers.

• Evaluate claims and adjustments.

• Address claims edits and claims that are on hold.

• Keep reference materials updated and available for claims adjudication.

• Offer backup assistance to fellow team or group members.

• Manually determine claim prices utilizing various tools and methods.

• Review daily updates to reference materials and provide feedback or raise concerns.

• Collaborate with the Quality team on procedures and complex claims.

• Receive guidance and coaching from leadership.

• Carry out additional responsibilities assigned by leadership that align with the role.

⛳️ Requirements

• Proven ability to navigate computer applications effectively.

• Familiarity with ICD-9/10 codes and Current Procedural Terminology (CPT).

• Basic analytical skills demonstrated.

• Proficient written and verbal communication skills.

• Demonstrated reading comprehension and ability to adhere to provided instructions.

• Previous claims work experience is mandatory.

• A GED or high school diploma is required.

• Must adhere to relevant legal, regulatory, contractual, security, and internal policy requirements.

🏝️ Benefits

• Potential eligibility for short-term incentives.

• Comprehensive benefits package available.

• Health, life, voluntary, and various other benefits offered.

• Benefits and perks that promote physical, mental, emotional, and financial wellbeing.

• Tobacco-free workplace environment.

• Equal Opportunity Employer.