Claims Processor

Overview:
The Claims Processor is responsible for accurately and efficiently processing healthcare claims submitted by our members and healthcare providers. The primary objective will be to review, evaluate, and adjudicate claims in accordance with established guidelines, procedures, and policies. This individual will work closely with other departments to resolve any outstanding discrepancies and ensure timely payment of claims.

Responsibilities:

Review and assess healthcare claims for accuracy, completeness, and compliance with insurance policies and regulatory requirements.

Accurately enter claim information into the adjudication platform, ensuring all necessary details are captured for processing.

Verify patient eligibility, coverage, and benefits to determine the validity of claims and ensure appropriate reimbursement.

Maintain detailed and organized records of all claims processed, including any correspondence or communication related to claim adjudication.

Investigate and resolve any discrepancies or issues identified during the claims review process, collaborating with internal teams and external stakeholders as needed.

Provide timely and professional responses to inquiries regarding claim status, coverage, and benefits application.

Adhere to all applicable laws, regulations, and industry standards governing healthcare claims processing including HIPAA guidelines.

Participate in quality assurance initiatives to ensure accuracy and consistency in claims processing, including HIPAA guidelines.

Stay informed about changes in healthcare regulations, insurance policies, and industry trends through ongoing training and professional development opportunities.

Perform other duties and responsibilities as assigned.

Minimum Qualifications:

Education: High School diploma or equivalent

Experience: 0 years' experience.

Licenses/Certifications: None

 

 

 

Why St. Luke's:
At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

 

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

 

*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.

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