Insurance Claims Processor

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

📋 Description

• Report directly to the Claims Manager.

• Analyze and process insurance claims, verifying their validity.

• Assess whether to return, deny, or approve claims in accordance with organizational policies and procedures.

• Screen and review online entries, correct errors, and ensure quality control for the final adjudication of paper and electronic claims.

• Evaluate the accuracy and completeness of claim information; input and verify claims data.

• Resolve claim edits, review historical records, and determine eligibility for benefits related to services.

• Review payment levels and make final payment determinations.

• Meet production and quality standards while managing work queues effectively.

• Communicate with both internal and external staff members.

• Escalate issues to the appropriate level of supervision when necessary.

• Ensure the accuracy of entered data and maintain records diligently.

• Attend mandatory training sessions and demonstrate proficiency in required skills.

• Carry out additional responsibilities as assigned by the Claims Manager.

⛳️ Requirements

• High School diploma or GED.

• One (1) year of experience in medical or institutional claim data entry OR one (1) year of experience in customer service.

• Ability to remain seated for extended periods.

• Working knowledge of administrative and clerical procedures, including word processing and file management.

• Ability to follow directions and navigate multiple systems simultaneously.

• Excellent skills in written and oral communication, customer service, interpersonal interactions, and telephone etiquette.

• Ability to resolve problems using predefined methods and guidelines.

• Proficiency in applying mathematics to adjudicate claims.

• Understanding of medical insurance payment requirements and basic knowledge of covered services.

• Strong attention to detail, organizational skills, and capability to handle multiple tasks at once.

• Familiarity with Microsoft Office Professional Suite, Internet Explorer, and EPIC.

• Availability for 40 scheduled hours per week.

🏝️ Benefits

• Comprehensive health insurance options.

• Retirement savings plans with employer contributions.

• Paid time off and holiday pay.

• Opportunities for professional development and training.

• Employee assistance programs.