Claims Processor

Claims Processor

Pay Range: $17.34hr - $21.34hr

The Claims Processor is responsible for examining, researching, and resolving non-adjudicated claims to ensure accurate and timely processing in accordance with medical policies, contracts, and procedures.

The role involves working across multiple systems, collaborating with internal teams, and maintaining productivity and quality standards.

Responsibilities:

• Examine and resolve non-adjudicated claims by identifying processing requirements based on contracts, medical policies, and procedures.
• Process product- or system-specific claims to ensure timely payment generation.
• Calculate deductibles and maximums and research and resolve pending claims.
• Utilize automated systems to pend claims for accurate completion in alignment with medical policy and contractual requirements.
• Research procedures and apply training materials, correspondence, and medical policies to ensure accurate claim processing.
• Partner with the Quality team for clarification on complex or difficult claims and receive coaching from leadership.
• Participate in ongoing developmental training to support daily functions.
• Complete daily productivity reporting used by leadership for performance tracking, workflow design, and planning.
• Collaborate with multiple departments to provide feedback, resolve issues, and answer basic processing questions.

Requirement/Must Have:

• High School Diploma or GED.

Experience:

• Less than one year of experience processing claim documents.

Should Have:

• Experience in claims processing, billing, or medical terminology.

Skills:

• Demonstrated analytical skills.
• Strong reading comprehension and ability to follow written directions.
• Basic written and oral communication skills.
• Proficiency in navigating computer applications.

Qualification And Education:

• High School Diploma or GED required.