Claims Processor II

CGS Administrators, LLC•Nashville, TN

2d•$13 - $24•Remote

About The Position

Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members. Description Logistics: CGS (cgsadmin.com) – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours-week) Monday-Friday from 8:00am-4:30pm and will be fully remote. What You’ll Do: Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctly. Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims. Researches and resolves claims edits and deferrals. Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicable.

Requirements

High School Diploma or equivalent
2 years of experience processing, researching and adjudicating claims.
Strong organizational, analytical and judgment skills.
Strong oral and written communication skills.
Proficient in spelling, punctuation and grammar.
Proficient in basic business math.
Ability to handle confidential or sensitive information with discretion.
Microsoft Office.

Nice To Haves

2 years of claims processing experience.
Strong time management skills.
Knowledge of mathematical and statistical concepts.
Proficient in word processing and spreadsheet applications.
proficient database software skills.

Responsibilities

Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
Verifies that claims have been keyed correctly.
Ensures that claims are processing according to established quality and production standards.
Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
Researches and resolves claims edits and deferrals.
Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
Responds to routine correspondence and completes spreadsheet if applicable.