Insurance Claims Processor

Jobtailor; Deutschland; Remote; EUR 30.000 - 42.000; Vollzeit

Zusammenfassung

Jobtailor in Germany is seeking a Claims Processor to analyze and adjudicate insurance claims, ensuring accuracy and alignment with policies. You will screen data, verify information, and determine payments while maintaining data integrity.

Responsibilities include entering claims data, reviewing history records, and communicating with internal and external staff. The role requires attention to detail and solid knowledge of medical insurance requirements.

Qualifikationen

• High School diploma or GED.
• 1 year of experience with medical or institutional claim data entry OR 1 year of customer service experience.
• Ability to sit for extended periods.
• Familiarity with administrative procedures and systems.
• Ability to navigate multiple systems simultaneously.
• Strong written and verbal communication and customer service skills.
• Ability to use math to adjudicate claims.
• Understanding of medical insurance requirements for payment.

Aufgaben

• Report to the Claims Manager and analyze and process insurance claims.
• Determine whether to return, deny, or pay claims per policies.
• Screen and review online entry and quality control for final adjudication.
• Enter and verify claims data and ensure accuracy.
• Review payment levels and final payment determinations.
• Meet production and quality standards and manage work queues.
• Communicate with internal and external staff and escalate issues as needed.
• Attend training classes and perform other duties as assigned.

Kenntnisse

Claims Processing

Data Entry

Customer Service

Microsoft Office

Communication

Ausbildung

High School Diploma

GED

Tools

EPIC

Microsoft Office

Internet Explorer

Jobbeschreibung

• Report to the Claims Manager
• Analyze and process insurance claims, checking for validity
• Determine whether to return, deny, or pay claims according to organizational policies and procedures
• Screen and review online entry, error correction, and quality control for final adjudication of paper/electronic claims
• Determine accuracy and completeness of claim information; enter and verify claims data
• Resolve claim edits, review history records, and determine benefit eligibility for services
• Review payment levels and arrive at final payment determinations
• Meet production and quality standards and maintain work queues
• Communicate with internal and external staff
• Escalate issues to the appropriate level of supervision
• Ensure accuracy of entered data and record maintenance
• Attend required training classes and demonstrate proficiency
• Perform other duties assigned by the Claims Manager

Requirements

• High School diploma/GED
• One (1) year of experience working with medical or institutional claim data entry OR One (1) year of customer service experience
• Ability to sit for extended periods of time
• Working knowledge of administrative and clerical procedures and systems such as word processing and managing files and records
• Ability to take direction and 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
• Ability to use mathematics to adjudicate claims
• Ability to understand medical insurance requirements for payment and basic knowledge of covered services
• Attention to detail, organization, and ability to perform multiple tasks simultaneously
• Familiarity with Microsoft Office Professional Suite, Internet Explorer, and EPIC
• 40 scheduled weekly hours

Core Competencies

Proficient in analyzing and processing insurance claims with a strong understanding of medical insurance requirements and payment adjudication. Demonstrates excellent communication and organizational skills while maintaining accuracy and attention to detail in data entry and claims management.

Highest-signal resume keywords

• Claims Analysis
• Medical Insurance Knowledge
• Data Entry Accuracy
• Customer Service Experience
• Microsoft Office Proficiency

Hard Skills

• Claims Processing
• Data Verification
• Mathematics for Claims Adjudication
• Error Correction
• Quality Control

Soft Skills

• Excellent Communication
• Interpersonal Skills
• Problem-Solving
• Attention to Detail
• Organizational Skills

Certifications & Qualifications

• High School Diploma
• GED

Industry Keywords

• Insurance Claims
• Claims Manager
• Benefit Eligibility
• Customer Service
• Administrative Procedures

Tools & Technologies

• Microsoft Office Professional Suite
• EPIC
• Internet Explorer