Claims Processor - Remote

Overview

The Claims Processor is responsible for screening, reviewing, and evaluating claims to ensure accuracy and compliance with organizational policies.

In Short

• Screen and review online entry of claims.
• Correct errors and perform quality control reviews.
• Determine whether to return, deny, or pay claims.
• Ensure timely and accurate completion of claims adjustments.
• Provide technical assistance in resolving inquiries.
• Maintain accurate records and attend required training.
• Meet production and quality standards.
• Communicate professionally with internal and external customers.
• Analyze claims data and make benefit determinations.
• Research and finalize claims adjustments and inquiries.

Requirements

• High School Diploma/GED required.
• 1 year of related experience required.
• Experience with inquiry resolution systems preferred.
• Strong verbal and written communication skills.
• Ability to navigate multiple systems simultaneously.
• Knowledge of administrative and clerical procedures.
• Ability to solve problems within defined guidelines.
• Experience in claims processing preferred.
• Ability to use mathematics for adjudicating claims.
• Ability to review and analyze critical data.

Benefits

• Competitive salary range.
• Opportunity for professional development.
• Supportive work environment.
• Access to health-related resources and services.
• Comprehensive training programs.