Healthcare Claims Processor Jobs

2 years of experience processing, researching, and adjudicating claims

Strong organizational, analytical and judgment skills

Strong oral and written communication skills

5 years-of experience processing and adjudicating claims

Knowledge of mathematical and statistical concepts

Examine and process complex or specialty claims according to business/contract regulations, internal standards and examining guidelines

Five or more years of healthcare claims experience.

Advanced knowledge in Microsoft Excel and other software for conducting quantitative analysis

Strong analytical and business process re-engineering skills

Strong written and oral communication and presentation skills to deliver messages to business leaders, clients and technical personnel

Ensure that “intent of change” is carried out through every project phase by participating in technical reviews and inspections.

An influencer and team player who that motivates others to action and communicates key technical ideas in a digestible way

2+ years' experience with data visualization in Tableau or PowerBI

2+ years' experience with SQL

We welcome 100% remote work for residents of the States of Oregon and Washington.

Required qualifications for this position include:

Preferred qualifications for this position include:

Check out our benefits page for more information about our Benefits and Rewards.

Knowledge of basic spreadsheet / word processing / data entry and basic math skills required.

Knowledge of Claims Management and URAC standards preferred.

Tracks claim detail errors and communicates to up-line management for coaching and training purposes.

Must have minimum 1 year work experience.

Two years of customer service, claims processing, medical terminology, medical services or equivalent experience required.

Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.

Major Functions (Duties and Responsibilities)

Major Functions (Duties and Responsibilities) Cont

Three (3) years experience in adjudicating medical claims.

Microcomputer skills, proficiency in Windows applications preferred. Eexcellent communication and interpersonal skills, strong organizational skills required.

Data entry involving computer keyboard and screens, filing and copying of records and/or correspondence.

A reasonable salary expectation is between $48,110.40 and $59,425.60, based upon experience and internal equity.

Minimum Education and Experience Requirements:

College education may be substituted for experience.

Prefer some college-level business, finance or accounting courses.

Experience in Blue Cross, Medicare, Medicaid and/or other third-party payer billing or collections preferred.

Must have above average math skills and be proficient on a calculator.

Experience with computerized insurance billing system and Microsoft programs preferred.

Our Comprehensive Benefits Package Includes

401(k) retirement savings plan with company match

Fantastic health plans and free vision coverage

Paid annual leave — the longer you work here, the more you earn.

Onsite cafeterias and fitness centers in significant locations

Wellness programs and a healthy lifestyle premium discount

1-3 years of relevant work experience including claims submission/processing experience

Excellent verbal and written communication skills

Problem-solving skills to analyze, troubleshoot and resolve issues

Structured thinker and love checking things off your to-do list

An innovative spirit to push the boundaries

Ability to thrive in a fast-paced, results-oriented environment

1-3 years of relevant work experience including claims submission/processing experience

Excellent verbal and written communication skills

Problem-solving skills to analyze, troubleshoot and resolve issues

Structured thinker and love checking things off your to-do list

An innovative spirit to push the boundaries

Ability to thrive in a fast-paced, results-oriented environment

Review, process, and resolve moderately complex claims in accordance with contracts and policies.

Research claims through the utilization of reference materials and on-line tools.

Responsible for accurately coding claims through the system.

Translate data into information acceptable to the claims processing system including follow up on pended claims.

Maintain all appropriate claims files and perform follow-up on pended claims.

Prepare claims for return to Provider or Subscriber when additional information is needed.

Knowledge of basic spreadsheet / word processing / data entry and basic math skills required.

Knowledge of Claims Management and URAC standards preferred.

Tracks claim detail errors and communicates to up-line management for coaching and training purposes.

Must have minimum 1 year work experience.

Two years of customer service, claims processing, medical terminology, medical services or equivalent experience required.

Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.

Strong analytical, organizational and customer service skills.

Strong oral and written communication skills.

Proficient spelling, punctuation and grammar skills.

One year-of experience in a healthcare or insurance environment

Research and process claims according to business regulation, internal standards and processing guidelines

Verifies the coding of procedure and diagnosis codes

• COB and benefit summary knowledge

• Pay or deny claims according to the benefit summary

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

• Knowledge of Medicaid, Medicare or commercial claims processing

• Experience with claims or customer service in medical field

• Review membership eligibility for determination

Requires basic job knowledge of systems and procedures obtained through prior work experience or education

Requires basic knowledge of systems and procedures and obtained through prior work experience or education

Knowledge of Medi-Cal and benefit plans

Be experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction

Experience front-end processing and difficult adjustments

Requires at least 3 years of experience

Daily and Monthly Pharmacy Benefit Manager (PBM)

Meet CMS guidelines and client Service Level Agreement (SLA) requirements through the proper handling of transactions

Minimum 2 years Health Plan Operations experience including; Enrollment (preferred), Claims processing or Customer Service.

Working knowledge of MSOffice (Word, Excel, Outlook)

Process queue items, inter-departmental and customer requests timely and accurately

Review incomplete and pending enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services (CMS)

In Depth Experience & Understanding of Coverage & Reimbursement, Member Enrollment, Provider Contracts, Benefits and Authorization and Claims Workflow

"A la Carte" Style Benefits

3+ Years of Experience in Data Analysis, Claims Configurations within QNXT or Similar Software/Application

$50.00 - $55.00 / Hourly Rate

Estimated 6 Month Contract Period

Paid Time Off / Sick Leave / Etc.

1 year-of experience in a healthcare or insurance environment.

Our Comprehensive Benefits Package Includes

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.

High School Diploma or equivalent

Ability to use complex mathematical calculations.

Remote - Must be within 100 miles of Richmond, VA

· Utilize investigation skills and document findings

· Gain extensive knowledge of Regulation E Become an expert in MasterCard chargeback rules

· Meet performance expectations related to productivity, effectiveness, and customer experience

· 1+ year of Financial Services experience

· Knowledge of Microsoft and/or Google Suite products

Prepare reports for management by collecting, analyzing, and summarizing claim information.

Maintain proper file documentation of assigned files by complying with company and state requirements.

2+ years of experience in the legal or medical field.

Experience with Professional Liability preferred.

Responsibilities include, but are not limited to:

Actively engage in review processes to evaluate liability, assess case value, and oversee reserving functions and total claims costs.

Higher in range - Experience and skills add value above typical requirements of the role

Lower in range - Building skills and experience in the role

Mid-range - Experience and skills align with proficiency in the role

Maintain and update various databases to meet departmental and QA requirements

Must have experience with auditing and/or filing claims for FHA, VA and/or USDA adhering to the Investor/Insurer’s guidelines

Retirement benefits, life insurance, 401k match, and tuition reimbursement