About the Role:

• As a Claims Processor, you will be responsible for reviewing and adjudicating paper/electronic claims under direct supervision.
• You will determine the proper handling and adjudication of claims following organizational policies and procedures.

Responsibilities:

• Examine and resolve non-adjudicated claims to identify key elements of processing requirements based on contracts, policies, and procedures. 
• Process product or system-specific claims to ensure timely payments are generated, calculate deductibles and maximums, and research and resolve pending claims.
• Use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies, and procedures.
• Complete research of procedures, apply training materials, correspondence, and medical policies to ensure claims are processed accurately.
• Complete productivity daily data used by leadership to compile performance statistics.
• Collaborate with multiple departments providing feedback, resolving issues, and answering basic processing questions.

Education Qualification:

• High School Diploma or GED

Required Skills:

• Less than one year experience processing claim documents.
• Preferred 1-3 years of claims processing, billing, or medical terminology experience.
• Demonstrated analytical skills.
• Proficient in reading comprehension and ability to follow directions provided.
• Proficient in basic written/oral communication skills.
• Proficient in navigating computer applications.
• Ability to work effectively in a fast-paced environment with changing priorities and deadlines.
• Ability to meet established deadlines and handle multiple customer service demands.
• Ability to provide positive customer service to internal and external customers.