Claims Processor II
About The Position
Responsible and accountable for accurate and timely processing of claims, maintaining a high level of detail and quality in accordance with claims payment policy and customer/provider contractual agreements. The role adjudicates claims and adjustments, resolves edits and suspended claims, and maintains and updates reference materials used in claims adjudication. It may provide backup support to other team members and manually price claims using various tools and processes. The processor reviews reference-material updates daily and shares feedback or concerns, partners with the Quality team for procedural clarity and complex claims, and receives coaching from leadership. Duties listed are representative rather than all-inclusive; leaders may assign additional or other duties aligned with the role. Employees must understand and comply with position-specific security responsibilities and controls, applicable legal, regulatory, and contractual requirements, and internal policies and procedures.
Requirements
- Claims work experience is required; no duration is specified.
- 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 directions.
- GED or high school education required.
Responsibilities
- Accurately and timely process claims in accordance with claims payment policy and customer/provider contractual agreements.
- Adjudicate claims and adjustments as required.
- Resolve claims edits and suspended claims.
- Maintain and update required reference materials for claims adjudication.
- Provide backup support to other team or group members as assigned.
- Manually price claims using various tools and processes.
- Review reference-material updates daily and share feedback or concerns.
- Partner with the Quality team for procedural clarity and assistance with complex claims.
- Comply with security responsibilities and controls, applicable requirements, and internal policies and procedures.
Benefits
- May be eligible for short-term incentives.
- Comprehensive benefits package, including a broad range of health, life, voluntary, and other benefits and perks supporting physical, mental, emotional, and financial wellbeing.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
