Claims Processor

2 days ago

Springfield, Illinois, United States Ampcus Full time
Job Title: Claims Processor

Ampcus Inc is a certified global provider of a broad range of Technology and Business consulting services. We are seeking a highly motivated candidate to fill this role.

Job Summary:

Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.

Responsibilities:
  1. Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures.
  2. Processes product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims.
  3. Uses 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.
Requirements:
  • High School Diploma or GED
  • Less than one year experience processing claim documents
Preferred Qualifications:
  • 1-3 years Claims processing, billing, or medical terminology experience

The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.

Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.

Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.

Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

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