Claims Processor 2-300411

GuideWell Source

3d • Remote

About The Position

This position is responsible for entering paper and/or electronic claims into the claims system and examining and determining whether to return, request additional information, deny or pay claims following organizational policies and procedures after entry. After the appropriate training, incumbents are expected to meet the minimum levels for quality and production as measured by the Claims Department.

Requirements

• High School Diploma or GED
• 1 year of data entry experience, including accurate keyboard skills
• Proficient with PC's and in Windows based environments; including Microsoft Office (Word, Excel, Outlook)
• Demonstrated analytical skills
• Strong verbal and written communication skills
• Strong interpersonal skills

Nice To Haves

• Knowledgeable of medical terminology, procedure and denial codes

Responsibilities

• Accurately examine, interpret and enter claims; resolve edits and first/second level suspense utilizing the claims processing system.
• Perform necessary research and effectively make decisions to properly adjudicate claims utilizing processing manual.
• Identify and communicate problems relevant to the claims processing system and the processing manual and/or guidelines.
• Adhere to all established standard operating procedures.
• Support continuous improvement by identifying process improvements and/or quality enhancements.
• Initiate and respond to written and verbal communications from internal and external sources.
• Perform Claim Adjustments of initial claims for internal and external adjustment reasons. This includes resolving claims suspensions resulting from claim adjustments.
• Resolve Medicare Secondary Payor (MSP) edits/audits/reason codes

Benefits

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED