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 customer/provider contractual agreements.

• Evaluate claims and adjustments.

• Address claims edits and manage suspended claims.

• Keep reference materials necessary for claims adjudication current and up to date.

• Offer backup assistance to fellow team members or groups.

• Manually price claims utilizing various tools and processes.

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

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

• Receive guidance and coaching from leadership.

• Undertake additional responsibilities as 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).

• Demonstrated foundational analytical skills.

• Basic proficiency in written and oral communication.

• Strong reading comprehension skills and the ability to follow given instructions.

• Prior experience in claims work is mandatory.

• A GED or high school diploma is required.

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

🏝️ Benefits

• Potential eligibility for short-term incentives.

• Comprehensive benefits package available.

• Options for health, life, voluntary, and various other benefits.

• Benefits and perks designed to support physical, mental, emotional, and financial wellbeing.

• A tobacco-free workplace environment.

• Equal Opportunity Employer.