Medical Claims Processor
2 months ago
Medical Claims Processor for a company in Foothill Ranch that serves medical providers, clients and patients.
This is a Temporary to Hire opportunity, pay rate $20-23/hr, depending on experience. Full-time, Monday - Friday, 7:00 AM - 4:00 PM, with a 1 hour unpaid lunch. This is 100% ON-SITE position. Ideal candidate will be organized and detail-oriented. Position offers mentorship and advancement opportunities.
Essential Responsibilities:
- In the Claims Processor role, you will be responsible for qualifying claims/bills for payment.
- Import claims received claims into specified cases and complete cases. Claims are received through EDI software system. Company uses Gotham Insurance, Aetna Insurance and United Insurance.
- Review and verify personal information including names, addresses, ages, and other data when reviewing claim submissions.
- Review claims which may require direct network contact.
- Responsible for contributing to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.
- Responsible for handling disputes, as well as processing corrected and reworked claims.
- The claims processor is required to create cases as needed, assist with incoming calls, as well as working closely with other departments.
- Manager inboxes for Gotham Insurance, Aetna Insurance and United Insurance.
- Adhere to company policies and local, state, and federal guidelines when facilitating claims processing.
- Other duties, as deemed necessary in the role as a claim’s processor.
Qualifications:
- High School diploma, GED, or equivalent to 1+ years of customer service experience OR experience in a medical office, health care Call Center or Office setting analyzing and solving customer problems.
- MUST HAVE fluency in basic computer systems like Microsoft Office, and/or risk assessment software.
- Should have some experience in fielding phone calls and emails in a high-volume setting such as in a customer service representative position.
- Must have strong critical thinking, problem-solving, decision-making, and communication skills.
Compensation / Pay Rate (Up to): $20.00 - $23.00 Per Hour
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