Processor, Claims I

PGBA,•Myrtle Beach, SC

2d•Hybrid

About The Position

Responsible for the accurate and timely processing of claims. This role involves researching and processing claims according to business regulations, internal standards, and processing guidelines, including verifying the coding of procedure and diagnosis codes. Additionally, the position requires resolving system edits, audits, and claims errors through research and the use of approved references and investigative sources. Coordination with internal departments is also necessary to work edits and deferrals, updating patient identification, other health insurance, provider identification, and other files as needed.

Requirements

High School Diploma or equivalent
Strong analytical, organizational and customer service skills.
Strong oral and written communication skills.
Proficient spelling, punctuation and grammar skills.
Good judgment skills.
Basic business math skills.
Basic office equipment.

Nice To Haves

1 year-of experience in a healthcare or insurance environment.
Ability to use complex mathematical calculations.
Proficient in word processing and spreadsheet applications.
Proficient in database software.

Responsibilities

Researches and processes claims according to business regulation, internal standards and processing guidelines.
Verifies the coding of procedure and diagnosis codes.
Resolves system edits, audits and claims errors through research and the use of approved references and investigative sources.
Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.