Senior Claims Processor
About The Position
Key Staffing is partnering with a leading healthcare organization in Visalia that is seeking an experienced Senior Claims Processor III. This position is responsible for processing complex medical claims while ensuring accuracy, compliance, and timely adjudication. The ideal candidate will have extensive experience processing high-dollar facility claims, a strong understanding of medical terminology and coding, and the ability to independently research and resolve complex claims issues. This role also serves as a resource for junior claims processors and assists with escalated provider and member inquiries.
Requirements
- 3–7+ years of health claims processing experience.
- Experience processing inpatient, outpatient, and high-dollar facility claims.
- Extensive knowledge of: Medical terminology, CPT coding, HCPCS coding, ICD coding.
- Knowledge of Coordination of Benefits (COB).
- Ability to interpret provider contracts and reimbursement guidelines.
- Strong analytical, problem-solving, and research skills.
- Experience handling escalated provider and member inquiries.
- Previous experience mentoring or training junior claims processors.
- Claims processing systems
- Microsoft Office Suite
- Medical billing and coding software
- Data entry and electronic documentation
Nice To Haves
- Associate's or Bachelor's degree in Healthcare Administration or a related field.
- Facility coding and/or medical billing credential preferred.
Responsibilities
- Process complex inpatient, outpatient, and high-dollar facility claims.
- Review and adjudicate medical claims accurately and efficiently.
- Verify claim accuracy, coding, and payment information.
- Interpret contracts and ensure claims are processed in accordance with applicable guidelines.
- Maintain productivity and quality standards while meeting processing deadlines.
- Independently research and resolve complex claims issues.
- Investigate discrepancies and coordinate with internal departments as needed.
- Handle escalated provider and member inquiries professionally and efficiently.
- Ensure all claims are processed in compliance with company policies and industry regulations.
- Serve as a mentor and resource for lower-level Claims Processors.
- Provide guidance on claims processing procedures and best practices.
- Assist in maintaining a high level of quality and accuracy across the claims team.
Benefits
- Higher compensation available based on experience and education.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
