Claims Processor

GLOBALHEALTH HOLDINGS LLC • Oklahoma City, OK

2d • Remote

About The Position

The Claims Processor processes contracted and non-contracted claims for Medicare, Medicaid, and commercial insurance products accurately and on time. Working with the Team Leader and/or Claims Supervisor, the role supports day-to-day claims operations and helps meet company, department, and regulatory standards for quantity, quality, and timeliness. The position requires independent work, goal attainment, and strong customer service and communication skills.

The current work environment is remote, subject to some state exclusions. The employee must have reliable, secure internet access and maintain the confidentiality and security of business information, including Protected Health Information (PHI), in accordance with HIPAA and company policies.

Requirements

• High school diploma or equivalent.
• Full understanding of insurance processes, including managed care, Medicare, Medicaid, and commercial practices.
• Working knowledge of medical claims processing guidelines and practices.
• Knowledge of Medicare and Health Care Finance Administration regulations.
• Knowledge of EOBs, CPT and ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs, and authorizations/referrals.
• Ability to read and interpret provider contracts.
• Strong verbal, written, and organizational skills.
• Self-directed and self-motivated, with analytical, problem-solving, and decision-making abilities.
• Accurate keyboard skills and basic math skills.
• Ability to work in a fast-paced, detail-oriented environment with a high degree of accuracy.
• Ability to work as a team player.
• Reliable and secure internet connection.

Nice To Haves

• Two years of medical claims processing experience is strongly preferred.

Responsibilities

• Process HCFA 1500 and UB92 claims according to daily productivity and quality standards, contractual and non-contractual agreements, and processing guidelines.
• Work with the Claims Supervisor or Manager to review processed and pended claims for appropriate, timely, and accurate processing.
• Coordinate with the Claims Manager to resolve customer service inquiries within 24 hours of receipt.
• Assist with claims adjustment projects as requested.
• Help with claims entry when requested.
• Complete work assignments from the supervisor in a timely manner.
• Maintain current desk procedures and reference materials.
• Protect confidential business information, including PHI, as required by HIPAA and company policy, and safeguard company records from unauthorized access, disclosure, or damage.
• Perform other duties as assigned.

What This Job Offers

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