Claims Processor I
1 week ago
Job Title: Claims Processor I
Client: Health Care Industry
Duration: 12 months contract role
Location: Fairfax, VA 22031
Job Description
Purpose:
- Under direct supervision, the Claims Processor I reviews and adjudicates paper/electronic claims. They determine proper handling and adjudication of claims following organizational policies and procedures.
Essential Functions:
- 60% - Examine and resolve non-adjudicated claims by identifying key processing elements based on contracts, policies, and procedures. Process product or system-specific claims to ensure timely payments, calculate deductibles and maximums, and resolve pending claims using automated systems.
- 25% - Conduct research on procedures, applying training materials, correspondence, and medical policies to ensure claims are processed accurately. Collaborate with the Quality team and leadership for clarity on procedures and complex claims, and participate in ongoing training.
- 10% - Complete daily productivity reports used by leadership for performance statistics, scheduling, quality improvement initiatives, workflow design, and financial planning.
- 5% - Collaborate with multiple departments, providing feedback, resolving issues, and answering basic processing questions.
Qualifications
To perform this job successfully, the individual must meet the following requirements:
Additional Skills:
- 2+ years of claims experience.
- Ability to recognize, analyze, and solve a variety of problems.
- Detail-oriented with exposure to healthcare, health insurance, medical information, and direct service experience (preferred).
Education Level:
- High School Diploma or GED
Experience:
- Less than one year of experience processing claim documents.
Preferred Qualifications:
- 1-3 years of claims processing, billing, or medical terminology experience.
Knowledge, Skills, and Abilities (KSAs)
- Analytical Skills: Proficient
- Reading Comprehension & Direction Following: Proficient
- Basic Written/Oral Communication Skills: Proficient
- Ability to Navigate Computer Applications: Proficient
Additional Information
- The incumbent must disclose any debarment, exclusion, or other events making them ineligible to work on Federal health care programs.
- Must work effectively in a fast-paced environment with changing priorities, deadlines, and variable workloads.
- Must meet established deadlines and handle multiple customer service demands within set expectations.
- Must effectively communicate and provide positive customer service to both internal and external customers, including those who may be demanding or challenging.
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