Claims Processor, Backend Expert
2 days ago
Your Role The Commercial First Pass Claims team is responsible for processing work in Enrollment, Claims, Provider, or other operational areas to meet operational, financial, and service requirements. These include timely and proper enrollment, adjudication of claims, or provider demographics updates in accordance with contractual requirements.
The Claims Processor reviews and adjudicates complex/specialty paper/electronic claims. Determines whether to return, deny, or pay claims following organizational policies and procedures. May provide guidance or expertise to less experienced claims processors.
This role reports to the Supervisor of Operations, Julie Pendergrass. You will be responsible for reviewing and adjudicating complex/specialty paper/electronic claims. Determining whether to return, deny, or pay claims following organizational policies and procedures. Additionally, you may provide guidance or expertise to less experienced claims processors.
Your Work In this role, you will:
- Be experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction
- Experience front-end processing and difficult adjustments
- Be given special processing assignments; coordinate with other departments for resolution if needed
- Understand fundamentals of end-to-end (life of a claim) claims processing
- Perform established performance metrics
- Strong ability to manage time effectively, multi-task, detailed research skills, meet deadlines with excellent quality
- Ability to work independently as well as in a team environment
- Ability to perform basic writing and arithmetic
Your Knowledge and Experience Requires a high school diploma or GED Requires at least 3 years of experience Basic experience in Microsoft Office Experience with excel preferred Math skills preferred
Estimated Salary Range: $18.61 - $26.05 for California positions based on experience and location.
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