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Claims Processor II

4 weeks ago

West Columbia, United States Spectraforce Technologies Full time
Title: Claims Processor II
Location: Columbia, SC 29229
Duration: 12 months assignment
Shift Timing: Monday- Friday 8am-4:30pm

Note: In person interviews.
Basic training will be 30 days, this is an inhouse position only.

Duties:
  • Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures.
  • Assists in training or mentoring new staff members.
  • 70% Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
  • Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
  • Verifies that claims have been keyed correctly.
  • 15% Ensures that claims are processing according to established quality and production standards.
  • Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
  • 15% Research and resolves claims edits and deferrals.
  • Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
  • Responds to routine correspondence and completes spreadsheet if applicable.


Skills:
  • Required Skills and Abilities: Strong organizational, analytical and judgment skills. Strong oral and written communication skills.
  • Proficient in spelling, punctuation and grammar.
  • Proficient in basic business math.
  • Ability to handle confidential or sensitive information with discretion.
  • Required Software and Tools: Microsoft Office.
  • Preferred Skills and Abilities: Strong time management skills.
  • Knowledge of mathematical and statistical concepts.
  • Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications.
  • proficient database software skills. Work Environment: Typical office environment.
Education
  • High School Diploma or equivalent
  • Required Work Experience: 2 years of experience processing, researching and adjudicating claims.
  • Preferred Work Experience: 5 years-of experience processing and adjudicating claims.