Job Details

Job Description:

• The Claims Processor is responsible for examining and resolving non-adjudicated claims, ensuring timely payments, and calculating deductibles and maximums.
• The role involves using automated systems to ensure accurate claim completion based on medical policies, contracts, and procedures.
• The Claims Processor also collaborates with multiple departments, provides feedback, and answers basic processing questions while contributing to performance data for leadership.

• Examine and resolve non-adjudicated claims by identifying key processing requirements based on contracts, policies, and procedures.
• Process product or system-specific claims to ensure timely payments, calculating deductibles, and resolving pending claims.
• Use automated systems to send pending claims for accurate completion according to medical policies and procedures.
• pply training materials, correspondence, and medical policies to ensure claims are processed accurately.
• Collaborate with the Quality team for clarification on procedures and difficult claims, receiving coaching from leadership.
• Participate in ongoing developmental training to improve performance.
• Complete daily productivity data to provide performance statistics for leadership, helping with scheduling, quality improvement, workflow design, and financial planning.
• Collaborate with multiple departments to provide feedback, resolve issues, and answer basic processing questions.

• Strong analytical skills.
• Proficient in reading comprehension and following provided directions.
• Basic written and oral communication skills.
• Proficiency in navigating computer applications.
• bility to effectively work in a fast-paced environment with changing priorities and deadlines.
• bility to meet established deadlines and handle multiple customer service demands.
• Strong customer service skills to handle challenging situations and provide positive experiences to internal and external customers.

• High School Diploma or GED.
• 3+ years of experience in processing claim adjudication.
• Experience with processing Inter-Plan Teleprocessing System (ITS) Claims.

• 5+ years of claims processing, adjudication, or medical terminology experience.
• Experience with LuminX claims processing system.