Medical Claims Processor

Kforce • Aurora, CO

30d • Remote

About The Position

Kforce has a client that is looking to hire Medical Claims Examiners. The role is fully remote, but candidates need to be located within 2 hours of the client's primary office site in Aurora, CO.

Requirements

• High School diploma or General Education Development (GED) required
• Qualified candidates will have a minimum of 3 years of experience in claims processing, ideally in a medical claims processing environment
• Must have experience doing full claims adjudication from start to finish and processing paid medical claims. (i.e., Processing medical claims that are paying out to the Providers and not from the Providers to insurance.

Responsibilities

• Medical Claims Examiner coordinates claim operations and modifications with other areas of the organization
• Monitors workflow to achieve established goals and objectives
• Responsible for abiding by all guidelines, procedures, and policies
• Learning and applying knowledge of medical claim/bill payment processing and medical regulations
• Utilize knowledge of organizational policies and procedures to ensure adherence to contractual agreements and non-contracted pricing arrangements along with compliance with government regulations
• Researches claims/bills for appropriate support documents and documentation
• Responds to vendor and member problems, questions and complaints

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Administrative and Support Services
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees