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Claims Processor
2 months ago
Terms of Employment
- Contract-to-Hire, 12 months
- This position is fully remote. Candidates must be based in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas.
- This is a full-time position, 40 hours per week.
Overview
Our client is seeking five (5) Claims Processors to review and adjudicate paper/electronic claims. Claims Processors will determine proper handling and adjudication of claims following organizational policies and procedures.
Responsibilities
- Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures.
- Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims.
- Use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
- Completes research of procedures.
- Applies training materials, correspondence and medical policies to ensure claims are processed accurately.
- Partners with the Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership.
- Participate in ongoing developmental training to perform daily functions.
- Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
- Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.
