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 for accurate completion according to medical policy, contracts, policies, and procedures
• Complete research of procedures, apply training materials, correspondence, and medical policies to ensure accurate claims processing
• Collaborate with the Quality team for clarity on procedures and/or difficult claims, receive coaching from leadership, and participate in ongoing developmental training
• Complete productivity daily data used by leadership to compile performance statistics for planning, quality improvement initiatives, workflow design, and financial planning
• Collaborate with multiple departments to provide feedback, resolve issues, and answer basic processing questions Education

Qualification: 

• High School Diploma or GED