Claims Processor II
About The Position
Responsible and accountable for accurate and timely processing of claims with a high level of detailed quality, in accordance with claims payment policy and the terms of customer/provider contractual agreements. The role adjudicates claims and adjustments, resolves claims edits and suspended claims, and maintains and updates reference materials needed for adjudication. It manually prices claims using various tools and processes, reviews reference material updates daily, and shares feedback or suggestions about concerns. The Claims Processor II partners with the Quality team for procedural guidance and complex claims and receives coaching from leadership. The role may also provide backup support to other team or group members and may be assigned additional duties aligned with the position. Employees must understand, comply with, and attest to position-specific security responsibilities and controls, as well as applicable legal, regulatory, contractual, and internal requirements.
Requirements
- Work experience in claims.
- Demonstrated ability to navigate computer applications.
- Experience with ICD-9/10 codes and Current Procedural Terminology (CPT).
- Demonstrated basic analytical skills.
- Basic written and oral communication skills.
- Demonstrated reading comprehension and ability to follow provided directions.
- GED or high school education.
Responsibilities
- Accurately and promptly process claims in accordance with claims payment policies and customer/provider contractual agreements.
- Adjudicate claims and adjustments as required.
- Resolve claims edits and suspended claims.
- Maintain and update reference materials required for claims adjudication.
- Provide backup support to other team or group members as assigned.
- Manually price claims using various tools and processes.
- Review updated reference materials daily and share feedback or suggestions when concerns arise.
- Partner with the Quality team for procedural clarity and assistance with complex claims, and receive coaching from leadership.
- Comply with position-specific security responsibilities and controls and applicable legal, regulatory, contractual, and internal requirements.
Benefits
- May be eligible for short-term incentives.
- Comprehensive benefits package, including health, life, voluntary, and other benefits and perks supporting physical, mental, emotional, and financial well-being.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
