Claims Processor - Remote

Overview

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

In Short

• Screen and review claims for accuracy.
• Perform quality control reviews and final adjudication.
• Determine claim status: return, deny, or pay.
• Resolve claim edits and ensure benefit eligibility.
• Maintain accurate records and meet production standards.
• Provide technical assistance in resolving inquiries.
• Utilize multiple systems for claims processing.
• Communicate professionally with customers.
• Adhere to HIPAA and company policies.
• Attend required training sessions.

Requirements

• High School Diploma/GED required.
• 1 year of related experience required.
• Preferred experience in claims processing.
• Strong verbal and written communication skills.
• Ability to solve problems within guidelines.
• Knowledge of administrative procedures.
• Experience with inquiry resolution systems.
• Ability to analyze critical data.
• Mathematical skills for adjudicating claims.
• Familiarity with claims processing operating systems.

Benefits

• Competitive salary range.
• Comprehensive health benefits.
• Opportunities for professional development.
• Work from home flexibility.
• Supportive work environment.