Claims Processor I

About This Role

Process claims accurately and efficiently while adhering to business regulations and internal standards. Collaborate with internal departments to resolve system edits and ensure data integrity.

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 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

Requirements

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

Qualifications

• High School Diploma or equivalent

Nice to Have

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

Skills

* Required skills

Benefits