Medical Claims Processor Jobs

Title: PE Claims Processor

Location: Remote, prefer from TX

Job description:

• Pay or deny claims according to the benefit summary

• Review membership eligibility for determination

• Assign correct provider for proper payment

• Follow all HIPA guidelines

• Review member’s out of pocket for correct cost share application

• Review COB information and apply it accordingly

• Review Error codes, warning messages and edits for correct processing

• Analyze claims for correct payment verification and adjust where needed

• Use of the Facets system to adjudicate claims

Preferred experience:

• Priority will be given to those with knowledge of the QNXT systems and application

• Knowledge of Medicaid, Medicare or commercial claims processing

• COB and benefit summary knowledge

Required:

• High school diploma or GED

• Experience with claims or customer service in medical field

• Ability to work independently and with others in a fast pace production based environment

• Basic Excel skills