Claims Processor

KMM Technologies, Inc.; Fairfax (VA); Remote; USD 40,000 - 60,000; Full time

Job summary

A leading company is looking for a Claims Processor to review and adjudicate claims in a remote setup. The role requires a High School diploma and 1-3 years of relevant experience. Essential functions include examining and resolving claims based on organizational policies, ensuring timely payments, and collaborating with multiple departments for issue resolution. The position offers opportunities for professional growth through ongoing developmental training.

Qualifications

• 1-3 years claims processing, billing or medical terminology experience.
• Proficient in navigating computer applications.
• Demonstrated reading comprehension and ability to follow directions.

Responsibilities

• Examine and resolve non-adjudicated claims to generate timely payments.
• Complete research of procedures and collaborate with the Quality team.
• Regularly report productivity data for performance statistics.

Skills

Claims Processing

Bill Experience

Accuracy in Keying

Organization

Reliable

Communication Skills

Analytical Skills

Education

High School Diploma or GED

Job description

Position: Claims Processor

Location: Fairfax, VA #Remote

Duration: Contract to Hire

Job Description

• Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.
• Required: Claims Processing/Bill Experience, Team Player, Accuracy in Keying, Organization and Reliable
• Education Level: High School Diploma or GED
• 1-3 years Claims processing, billing, or medical terminology experience
• Demonstrated analytical skills, Proficient
• Demonstrated reading comprehension and ability to follow directions provided, Proficient
• Basic written/oral communication skills, Proficient
• Demonstrated ability to navigate computer applications, Proficient
  
  

Essential Functions

60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.

25% Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.

10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.

5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

Thanks & Regards,

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LAXMAN

Team Lead - Talent Acquisition

KMM Technologies, Inc.

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