Claims Technician ALBUQUERQUE

HCSC•Albuquerque, NM

3d•Hybrid

About The Position

The Claims Technician processes complex healthcare claims requiring further investigation, including coordination of benefits and resolution of pended claims. The role reviews, processes, and adjudicates claims accurately and efficiently in accordance with company policies, payer guidelines, and regulatory requirements. It investigates claim discrepancies, researches denials, verifies member and provider information, and works toward timely claim resolution. The technician collaborates with internal departments, providers, and members to resolve claim issues while maintaining accuracy, productivity, compliance, and customer service standards. The position is based out of Albuquerque, New Mexico. Mandatory onsite training runs Monday through Friday, 8 a.m. to 5 p.m., with strict attendance requirements. After successful completion of the required training, work-from-home provisions will be established. The position may require returning for onsite training at a designated Customer Service Hub for up to 18 months. Employees hired and assigned to a Customer Service Hub must live near a designated hub. Starting pay is $17.75 per hour, with a stated base pay range of $17.75 to $26.17. Compensation may vary based on job-related skills, education, knowledge, experience, and location. The role aligns with an annual incentive bonus plan, subject to its terms and conditions. Periodic overtime may be required at the employer’s discretion based on business needs.

Requirements

High school diploma or GED.
Solid data-entry and/or typing experience.
Proficiency in Microsoft Office Suite, including Excel for data review and reporting.
Clear and concise written and verbal communication skills.
Experience processing medical claims and ability to manage high-volume workloads while maintaining quality metrics.
Strong attention to detail, problem-solving, and organizational skills.

Nice To Haves

Training on the six- or eight-week Blue Chip claims processing system, or ability to complete the six- or eight-week Blue Chip Training class.
Knowledge of medical terminology and CPT, HCPCS, and ICD9 coding.
Knowledge of coordination of benefits principles and terminology.
Familiarity with claims adjudication systems and healthcare payer processes.
Experience multitasking and prioritizing.

Responsibilities

Process complex claims in various queues, investigating missing information and using resource materials and support files to adjudicate claims accurately and promptly.
Contact providers as necessary to resolve claim questions or obtain information.
Resolve complex pended claims, duplicate claims, and claim adjustments.
Process claims involving communications with participating plans and/or Service Units, and resolve related issues.
Research and identify other insurance, Medicare, and Medicaid; update patient files as needed.
Coordinate benefits and request explanations of benefits as needed.
Maintain working knowledge of medical terminology and CPT, HCPCS, and ICD9 coding.
Maintain knowledge of specific contracts.
Read appropriate files in IMAGE and apply information to claims as needed using the Financial Suspense System (FSS).
Learn and maintain knowledge of DOL ERISA and prompt pay legislation.
Collaborate with internal departments, providers, and members to resolve claim issues.