Claims Processor

Allied Benefit Systems, Inc.; Illinois; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking an Assistant Claims Specialist to join their dynamic team. In this entry-level role, you will be responsible for processing medical and dental claims, ensuring compliance with client-specific plans, and making determinations regarding payments. This position offers a competitive salary and benefits package, alongside opportunities for professional growth. If you have a keen eye for detail and a desire to excel in a supportive environment, this role is perfect for you.

Benefits

Competitive Benefits Package

Qualifications

• Minimum two years of medical claims analysis experience required.
• Knowledge of CPT and ICD-10 coding is essential.

Responsibilities

• Process at least 1,200 claims weekly while maintaining quality standards.
• Review and analyze claims for cost reasonableness and fraud.

Skills

Analytical Skills

Knowledge of CPT Coding

Knowledge of ICD-10 Coding

Communication

Customer Focus

Education

High School Diploma

Tools

QicLink System

Job description

Job Details

Job Location: Allied Benefit Systems - CHICAGO, IL

Position Type: Full Time

Salary Range: $19.00 - $21.00 Hourly

Job Category: Claims

Description

POSITION SUMMARY

The Assistant Claims Specialist is an entry-level position responsible for claim processing. This role involves reviewing, analyzing, and making determinations regarding payment, partial payment, or denial of medical and dental claims, as well as invoices, based on specific client plans.

ESSENTIAL FUNCTIONS:

• Process at least 1,200 claims weekly while maintaining quality standards.
• Read, analyze, and ensure compliance with client-specific plans.
• Adhere to privacy and security laws, including HIPAA and HITECH.
• Review and analyze claims for cost reasonableness, unnecessary treatment, and fraud.
• Document notes in the QicLink system.
• Check billing codes for irregularities.
• Assess claims for billing inconsistencies and medical necessity.
• Authorize payment, partial payment, or denial based on analysis.
• Manage workflow and pending claims daily.
• Support other Claims Specialists as needed.
• Attend required continuing education, including HIPAA training.

Education:

• High School diploma or equivalent required.

Experience & Skills:

• Minimum two years of medical claims analysis experience (Medicare/Medicaid excluded).
• Prior experience with a TPA is preferred.
• Knowledge of CPT and ICD-10 coding required.
• Strong analytical skills and computer proficiency.
• Desire to exceed team goals.
• Experience with dental and vision claims is a plus but not required.

Core Competencies:

• Communication
• Customer Focus
• Accountability
• Technical Skills

Physical Demands:

• Sitting for long periods in an office setting.

Work Environment:

• Remote

Additional notes: This description covers essential functions but is not exhaustive. Compensation includes a competitive benefits package and may be adjusted at the company's discretion.