Claims Processor IV

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

📋 Description

• Accurately enter and finalize all assigned claims.

• Review, investigate, and resolve claims of moderate to high complexity in a timely manner.

• Reprocess claims related to organ transplants, SCCA, BDCT, benefit exchanges, and significant hospital bills.

• Collaborate with various business units, including Configuration, Customer Service, and Marketing Liaisons, to resolve claims issues.

• Identify and recommend procedural changes while assisting in updating processes and procedures.

• Offer specialized knowledge in complex claims processing to Care Facilitation, Customer Service, Appeals, benefit configuration, and claims teams.

• Perform accumulator adjustments, load deductible credits, and conduct member history evaluations.

• Reprocess carve-out claims and handle associated documentation.

• Serve as the team subject matter expert by training, auditing claims, and providing constructive feedback and coaching.

• Complete specialized tasks such as auditing, updating procedures, and coordinating with configuration.

• Achieve cycle time and productivity objectives.

• Convert data into formats suitable for the claims processing system and follow up on pending claims.

• Uphold confidentiality and apply quality standards to minimize defects and rework.

⛳️ Requirements

• High School diploma or GED (Required)

• Two (2) years of experience in claims processing within medical and/or dental plans, or two years of previous experience in a medical and/or dental office/insurance industry (Required)

• In-depth processing knowledge of Premera processing systems (Preferred)

• Demonstrated ability to audit fellow processors (Preferred)

• Familiarity with Out-of-area programs (Preferred)

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

• Proficient typing skills.

• Ability to communicate clearly and effectively in person and over the phone.

• Must maintain the confidentiality of documents and files.

🏝️ Benefits

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

• Optional benefits, including pet insurance.

• Life and disability insurance.

• 401K employer matching.

• Pension plan that vests after three years of service.

• Wellness incentives and mental health resources, including counseling, stress management, and mindfulness programs.

• Generous paid time off.

• Tuition assistance for undergraduate and graduate programs.

• Employee recognition initiatives.

• Commuter benefits.

• Free, convenient on-site parking.

• Subsidized on-campus cafes.

• On-site health and wellness activities.

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

• Shuffleboard and ping pong available on campus.