Claims Processor I

1 week ago

Fairfax, United States Three Point Solutions Full time
Job DescriptionJob Description

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.

#ZR

Company DescriptionAs a leading contract, contract-to-hire and professional placement firm, Three Point Solution understands the importance of aligning our client with the right resource at the right time. We are committed to the highest caliber of service that will benefit our clients, candidates and employees. Unlike large, corporate style recruiting firms, we commit to individualized attention that uniquely positions us to bridge the communication gap between recruiter, employer and candidate. Our goal is to cultivate and maintain true partnerships with our clients and candidates.Company DescriptionAs a leading contract, contract-to-hire and professional placement firm, Three Point Solution understands the importance of aligning our client with the right resource at the right time. We are committed to the highest caliber of service that will benefit our clients, candidates and employees. Unlike large, corporate style recruiting firms, we commit to individualized attention that uniquely positions us to bridge the communication gap between recruiter, employer and candidate. Our goal is to cultivate and maintain true partnerships with our clients and candidates.

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