Claims Processor II

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

📋 Description

• Review, process, and resolve moderately intricate claims in line 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 claims that are pending.

• Maintain claims files and conduct follow-ups on pending claims.

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

• Exhibit adjudication expertise to meet or surpass accuracy objectives.

• Achieve cycle time and productivity targets that align with corporate goals.

• Uphold the confidentiality of documents and files.

• Communicate with other carriers or provider offices as necessary.

• Provide training and feedback to new associates as needed.

• Execute adjustments, reversals, and/or refunds when required.

• Implement quality practices to prevent defects and reduce internal rework.

⛳️ Requirements

• High School diploma or GED (Required).

• At least six (6) months of claims processing or customer service experience (Required).

• Familiarity with the Out-of-area program.

• Technical knowledge of contract benefits, claims processing procedures, and correction methods.

🏝️ Benefits

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

• Voluntary benefit options, including pet insurance for pet owners.

• Life and disability insurance.

• Retirement programs, featuring a 401K employer match and a pension plan that vests after 3 years of service.

• Wellness incentives that include mental well-being resources, counseling services, stress management programs, and mindfulness initiatives.

• Generous paid time off.

• Tuition assistance for undergraduate and graduate degrees.

• Employee recognition program.

• On-campus flexibility, on-site resources, networking opportunities, and team engagement for hybrid workers.

• Commuter benefits.

• Free convenient on-site parking.

• Subsidized on-campus cafes.

• Engaging on-site health and wellness activities.

• A fitness and well-being center offering both in-person and virtual workouts, as well as nutritional counseling.