Claims Processor II

7 days ago

minor outlying islands us Magellan Health Services Full time
Responsible and accountable for the accurate and timely processing of all claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements. Adjudicates claims and adjustments as required. Resolves claims edits and suspended claims. Maintains and updates required reference materials to adjudicate claims. Provides backup support to other team/group members in the performance of job duties as assigned. Manually prices claims with various tools and processes to pay the claims. Utilizes reference materials and analyzes updated materials to adjudicate claims. This includes reviewing material updates daily and sharing feedback or suggestions if any concerns arise.  Partners with the Quality team for clarity on procedures and complex claims and receives coaching from leadership.

Other Job Requirements

Responsibilities

Demonstrated ability to navigate computer applications.
Experience with list of ICD-9/ codes and Current Procedural Terminology (CPT).
Demonstrated basic analytical skills.
Basic written/oral communication skills.
Demonstrated reading comprehension and ability to follow provided directions.

General Job Information

Title

Claims Processor II

Grade

Work Experience - Required

Claims

Work Experience - Preferred

Education - Required

GED, High School

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

Salary Range

Salary Minimum:

$,

Salary Maximum:

$,

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

  • Business Analyst II

    7 days ago

    minor outlying islands, us Magellan Health Services Full time

    Preferred Qualifications - Encounters: Outbound Encounters Submissions Knowledge of X format to include , and files. Professional experience in the managed care, healthcare, Medicaid or other health insurance industries. Experience in Healthcare claims operations and/or encounter submissions preferred. Experience in a data warehouse environment and...

  • RCIS Crop Claims Field Adjuster II

    7 days ago

    virtual, ne, us Zurich Insurance Company Full time

    Zurich is currently looking for a RCIS Crop Claims Field Adjuster II to work out of the state of Nebraska. This incumbent will work from a home-based office. This position is scheduled to work 40 hours per week. Approximately 50% travel is expected to cover the territory.  The ideal candidate will need to live and service within a 100-mile area of the...

  • Mortgage Loan Processor II

    7 days ago

    ar, us Centennial Bank Full time

    GENERAL DESCRIPTION OF POSITION The Mortgage Loan Processor II processes mortgage loans from application to closing. This position complies with all legal and regulatory guidelines related to the mortgage loan industry. The Mortgage Loan Processor II improves customer service by processing all loans in a timely manner. ESSENTIAL DUTIES AND...

  • Claim Benefit Specialist

    7 days ago

    oregon, work at home, us CVS Health Full time

    Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...

  • Account Resolution Specialist II

    7 days ago

    (multiple states), us Currance Full time

    We are hiring in the following states:AZ, CA, CO, CT, FL, GA, HI, IL, MA, ME, MN, MO, NC, NJ, NV, OK, PA, SD, TN, TX, VA, WA This is a remote position .Candidates who meet the minimum qualifications will be required to complete a video prescreen to move forward in the hiring process.  Hourly Rate:Up to $21.00/hour based on experience At Currance, we believe...

  • Coder II, Professional

    7 days ago

    remote, missouri, us SSM Health Full time

    JOB DESCRIPTION It's more than a career, it's a calling MO-REMOTE Worker Type: Regular Job Highlights: ·Department: Coding ·Patient Population or Ratio: N/A ·Sign On Bonus: $1, ·Schedule: Full Time, Day Shift ·Starting Pay: $23.86 (Offers are based on years of experience and internal equity for this role ·Shift Differentials: Available for...

  • Accounts Receivable Specialist

    6 days ago

    (multiple states), us Infinx Full time

    Ni2 Health is actively recruiting an Accounts Receivable Specialist to join our Revenue Cycle Team.   The ideal candidate is action oriented and looking to learn and grow with Ni2 to advance within the organization.   The Accounts Receivable Specialist will:  Have proven experience with hospital inpatient, outpatient, CAH, Method I & II, RHC and...

  • Market Facing Underwriting Manager

    3 days ago

    long island, ny, us Zurich Insurance Company Full time

    What can go right when you can grow your career? Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, we have over 150 years of experience, serve more than 25 industries, and...

  • Accounts Receivable Specialist

    6 days ago

    (multiple states), us Infinx Full time

    ABOUT THE ROLE  Ni2 Health is actively recruiting for an Accounts Receivable (AR) Specialist to join our Revenue Cycle Team.  The ideal candidate is action oriented and looking to learn and grow with Ni2 to advance within the organization.  The AR Specialist will:  Have proven experience with hospital Inpatient, outpatient, CAH, Method I & II, RHC and...

  • Licensed Life and Health Call Center Representative

    7 days ago

    ms, us Mass Markets Full time

    POSITION OVERVIEW Job Title: Licensed Life and Health Call Center Representative Job Type: Full-Time  Location: Mississippi MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have...

  • Licensed Life and Health Insurance Advisor

    7 days ago

    mo, us MCI, LC Full time

    POSITION OVERVIEW Job Title: Licenced Life and Health Insurance Agent Job Type: Full-Time  Location: Missouri MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have established...

  • Licensed Health Insurance Representative

    7 days ago

    ar, us Mass Markets Full time

    POSITION OVERVIEW Job Title:  Licensed Health Insurance Representative Job Type:  Full-Time  MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have established ourselves as a...

  • Licensed Life and Health Insurance Advisor

    7 days ago

    ok, us Mass Markets Full time

    POSITION OVERVIEW Job Title: Licenced Life and Health Insurance Agent Job Type: Full-Time  Location: Oklahoma MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have established...

  • Licensed Life and Health Insurance Specialist

    7 days ago

    al, us Mass Markets Full time

    POSITION OVERVIEW Job Title: Licensed Life and Health Insurance Specialist Job Type: Full-Time  Location: Alabama MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have...

  • Licensed Life and Health Insurance Specialist

    7 days ago

    nc, us Mass Markets Full time

    POSITION OVERVIEW Job Title: Licensed Life and Health Insurance Specialist Job Type: Full-Time  Location: North Carolina MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have...

  • Licensed Health Insurance Advisor

    7 days ago

    tn, us MCI, LC Full time

    POSITION OVERVIEW Job Title: Licensed Health Insurance Agent Job Type: Full-Time  Location: Tennessee MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have established ourselves...

  • Licensed Life and Health Insurance Advisor

    7 days ago

    ok, us MCI, LC Full time

    POSITION OVERVIEW Job Title: Licenced Life and Health Insurance Agent Job Type: Full-Time  Location: Oklahoma MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have established...

  • Licensed Life and Health Call Center Representative

    7 days ago

    tn, us MCI, LC Full time

    POSITION OVERVIEW Job Title: Licensed Life and Health Call Center Representative Job Type: Full-Time  Location: Tennessee MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have...

  • Licensed Life and Health Call Center Representative

    7 days ago

    va, us Mass Markets Full time

    POSITION OVERVIEW Job Title: Licensed Life and Health Call Center Representative Job Type: Full-Time  Location: Virginia MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have...

  • Licensed Life and Health Call Center Representative

    7 days ago

    ok, us Mass Markets Full time

    POSITION OVERVIEW Job Title: Licensed Life and Health Call Center Representative Job Type: Full-Time  Location: Oklahoma MCI is a leading Business Process Outsourcing (BPO) company that specializes in delivering tailored solutions to meet the diverse needs of our clients. With a commitment to excellence and a focus on innovation, we have...