Claims Processor II

This is a fully remote position, open to applicants in Alaska, +26 more states.

📋 Description

• Evaluate, process, and resolve moderately complex claims in alignment with contracts and policies.

• Investigate claims utilizing reference materials and online resources.

• Precisely code claims within the system.

• Convert data into information suitable for the claims processing system and follow up on outstanding claims.

• Organize claims files and carry out follow-ups on pending claims.

• Prepare claims for return to providers or subscribers when further information is required.

• Exhibit adjudication expertise to meet or surpass accuracy targets.

• Achieve cycle-time, productivity, accuracy, and quality objectives.

• Uphold confidentiality of documents and files.

• Communicate with other carriers or provider offices as required.

• Offer buddy training and constructive feedback to new associates as necessary.

• Process adjustments, reversals, and/or refunds as required.

• Implement quality practices to mitigate defects and internal rework.

⛳️ Requirements

• High School diploma or GED. (Required)

• Six (6) months of claims processing experience or customer service experience. (Required)

• Familiarity with out-of-area programs. (Preferred)

• Technical knowledge of contract benefits, claims processing steps, and correction procedures. (Preferred)

• Ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or consistently.

• Proficient in keyboarding and able to communicate clearly and understandably in person and over the telephone.

🏝️ Benefits

• Medical, vision, and dental plans with low employee premiums.

• Optional benefit offerings, including pet insurance.

• Life and disability insurance.

• Retirement programs, including a 401K employer match and a pension plan vested after 3 years of service.

• Wellness incentives and mental well-being resources, including counseling, stress management, and mindfulness programs.

• Generous paid time off.

• Tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program.

• Flexible on-campus routine and access to on-site resources, networking opportunities, and team engagement for hybrid employees.

• Commuter perks.

• Free convenient on-site parking.

• Subsidized on-campus cafes.

• Engaging on-site activities such as health and wellness events, coffee connects, and disaster preparedness fairs.

• Fitness and well-being center offering in-person and virtual workouts as well as nutritional counseling.

• On-site recreation facilities including shuffleboard and ping pong.