Insurance Claims Processor
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Job Description
Claims Processor analyzing and processing insurance claims in a remote setting. Requires a high school diploma and one year of relevant experience.
Responsibilities:
- Determines accuracy and completions of claim information
- Entry/verifies claims data
- Resolves claim edits, review history records, and determines benefit eligibility for service
- Reviews payment levels to arrive at final payment determination
- Meets all production and quality standards, maintaining workques according to department standards
- Effectively communicates with internal and external staff
- Elevates issues to next level of supervision, as appropriate
- Ensures accuracy of data entered and record maintenance
- Attends all required training classes, demonstrating proficiency and ability to learn
Requirements:
- High School diploma/GED
- One (1) year of experience working with medical or institutional claim data entry OR customer service experience
- Associate Degree in related healthcare field (preferred)
- Two plus years of medical or institutional claims processing and customer service experience (preferred)
- Working Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records
- Ability to take direction and to navigate through multiple systems simultaneously
- Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette
- Ability to solve problems with predefined methods and guidelines to drive improved efficiencies and customer satisfaction
- Basic knowledge of covered services
- Knowledge and understanding of medical terminology, third party payors and insurance preferred
Benefits:
- Standard office environment with electrical equipment (i.e., telephone, personal computer, copier, fax machines, etc.)
- Health insurance
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