Claims Processor

Claims Processor

Pay Rate: Various based on experience, which may be below your state's minimum wage. Please take this into consideration when applying.

Remote Role

Hours: 8:30 AM - 5:00 PM EST Mon to Fri

Job Summary: 

As a Claims Processor at Conduent, you'll have an opportunity to work in claims services. You will be surrounded by a culture that recognizes each person's contributions. Each day, you'll feel challenged and know you are making a difference in the lives of millions.

Key Responsibilities: 

• Review images of paperwork from benefits plan participants, utilizing all resources, procedures, and critical-thinking skills to determine eligibility for request and submit electronic transactions according to client and client/plan specific rules and IRS regulations and guidelines. 
• Must be able to work in a fast-paced environment with multiple transactions daily
• Activities include:
  • Electronic document preparation and indexing into case management system.
  • Review and research document images of returned mail to determine validity of address. Notate and flag participant's account if determination is made that address is no longer valid.
  • Determine if requested transaction meets plan eligibility rules, as well as IRS regulations and guidelines. 
  • Understand "gray areas" of IRS guidelines, effectively applying these guidelines to each case processed.
  • Review legal guardianship, conservatorship and power of attorney records if transaction is requested by a party other than the participant to determine if that party is authorized to request the specific transaction. 
  • Review paperwork for completeness and accuracy, including completion of all required fields and notarization, if required, and inclusion of legal documents such as birth certificate copies. Paperwork can be 30 pages or more, especially pension packages.
  • Calculate eligible reimbursement based on available funds, requested amount, requested reimbursement, previous reimbursements and substantiated documentation.
  • Review history of requests, transactions, and call notes to determine if prior transactions disqualify the request, if previously incomplete paperwork is now complete, or if other exceptional conditions exist
  • Maintain and update case management system notes.
  • Follow-up on open items daily and close cases upon completion. Cases can remain open for days, weeks or months if initial paperwork is incomplete, or requires an exception determination or future event is pending.
  • Collaborate with other internal departments and third-party vendors to obtain exception processing information and address participant or client escalations.
  • May be tasked with peer review on work completed by other peers.
• Associate will be measured on accuracy and speed
• Must be able to navigate multiple computer tools simultaneously
• Request assistance if special exception conditions are not covered well enough in knowledgebase applications and IRS regulations and guidelines.

Qualifications and Skills:

To be successful in this role you will:

• High School Diploma required
• An Associate's Degree in Business, Healthcare or related field preferred
• 2+ years of experience in an analytical/claims role strongly preferred
• Successful candidates may have experience in
  • Health & Welfare Claims Service Representative
  • Enrollment Data Analyst
  • Documentation Specialist in the field of Health Care, Eligibility Determination, or a similar field.
• Experience in Health & Welfare Preferred (but not required)
• Strong critical thinking and attention to detail skills required
• Must pass an internet speed test (download equal to or greater than 25, upload equal to or greater than 5, Ping ms equal to or less than 175)  
• Must have the ability to connect with an ethernet cable to a modem/router  
• Live in one of the following states AL, AR, AZ, CO, CT, DE, FL, GA, ID, IN, IA, KS, KY, LA, ME, MI, MS, MO, NE, NV, NH, NJ, NM, NC, ND, OH, OK, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY 

Join a rapidly growing organization that can support your career goals.

What you get:

• Paid Training
• Career Growth Opportunities
• Full Benefit Options
• Great Work Environment

Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information.  For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $33,600 - $42,000.

We are currently NOT hiring in the following geographies, including but not limited to: States: AK, CA, HI, MA, IL, MT & NY 
Metro Areas: MN – Minneapolis, IL – Chicago, NY – New York City, OR - Portland, MD - Montgomery County, WA - Seattle, Washington, DC