Claims Processor

National Healthcare Solutions, Inc. • El Paso, TX

6h

About The Position

As a Claims Processor, you will play a pivotal role in ensuring the efficiency and accuracy of claims processing within our organization. Your responsibilities will encompass a wide range of tasks, including year-end processing, managing adjustments, coordinating benefits, handling subrogation and high-dollar claims, processing Medicaid claims and complex appeals, and engaging in hospital audits.

Requirements

• Minimum of 1-3 years of experience in claims processing or related field.
• Strong understanding of claims processing procedures, including familiarity with medical terminology and insurance policies
• Highly detail-oriented with a focus on accuracy and quality assurance in claims processing
• Strong analytical and problem-solving skills with the ability to identify root causes and develop solutions.
• Experience handling escalated issues and making sound decisions under pressure.

Nice To Haves

• Bachelor's degree

Responsibilities

• Oversee and facilitate the year-end processing activities to ensure timely and accurate closure of claims records.
• Process adjustments to claims as needed, ensuring proper documentation and adherence to company policies and procedures.
• Manage coordination of benefits for claims.
• Handle subrogation claims and high-dollar claims, applying sound judgment and attention to detail in reviewing and processing these complex cases.
• Process Medicaid claims and assist in handling complex appeals, demonstrating a thorough understanding of Medicaid regulations and procedures.
• Conduct hospital audits to ensure compliance with contractual agreements and regulatory requirements.
• Analyze case management reports and make sure they are filed to the correct member.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 11-50 employees