Healthcare Claims Processor

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

📋 Description

• Assess, process, and adjudicate professional, facility, complex, and high-value medical claims.

• Utilize analytical and problem-solving abilities to understand program policies, coding regulations, and compliance guidelines.

• Process claims within stipulated timeframes and rectify discrepancies to ensure adherence to timeliness and quality benchmarks.

• Address claim variances and work collaboratively with cross-functional teams to pinpoint root causes and develop corrective measures.

• Safeguard member information and adhere to HIPAA and program-specific confidentiality standards.

• Observe and report on trends, recurring issues, and claim irregularities to enhance operational reporting and improve workflows.

• Assist in internal and external audits by supplying documentation, clarifying claim results, and affirming compliance.

• Aid in operational ramp-ups, managing backlogs, and adapting to shifting workload priorities.

• Contribute to the operations of the World Trade Center Health Program’s Third-Party Administrator at GDIT.

⛳️ Requirements

• At least 5 years of practical experience in processing medical professional and facility claims, including complex and high-value claims.

• Familiarity with ICD-10, CPT, and HCPCS coding systems.

• Proven experience with modifiers, bill types, and standard adjudication protocols.

• Strong comprehension of medical terminology, healthcare delivery systems, and insurance operations.

• Experience in workers’ compensation is advantageous.

• High attention to detail with a track record of accuracy in high-volume processing settings.

• Capability to interpret and apply program regulations, payer rules, and federal guidelines.

• Dedication to continual training and staying updated on coding standards, regulatory modifications, and system enhancements.

• Proficiency in claim denial resolution and appeals processes.

• Strong analytical skills and a customer-service orientation with effective problem-solving capabilities.

• MBI (T2) public trust or other required clearances.

• US citizenship is not mandatory.

🏝️ Benefits

• Extensive medical plan options, including some with Health Savings Accounts.

• Dental plan choices available.

• Vision plan selections.

• 401(k) plan offering pre-tax and post-tax contribution options with company matching.

• Flexible work weeks when feasible.

• Paid time off plans encompassing vacation, sick leave, personal time, holidays, paid parental leave, military leave, bereavement, and jury duty leave.

• Typically, 15 days of paid leave annually.

• 10 paid holidays each year.

• Up to 160 hours of paid family leave over a rolling 12-month period for qualifying employees.

• Short- and long-term disability insurance.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.

• AI-driven career tool identifying advancement and learning opportunities.

• Internal mobility team assisting with career aspirations.

• Wellness programs.

• Competitive salary.

• Recognized culture of innovation.

• Military-friendly workplace.