Claims Processor (53334)

GlobalHealth; Oklahoma City (OK); Remote; USD 32,000 - 54,000; Full time

Job summary

GlobalHealth currently seeks a Claims Processor to handle Medicare, Medicaid and Commercial claims remotely from the US. The role emphasizes accurate processing, adherence to HIPAA guidelines, and timely customer service. It requires a high school diploma and preferably two years in medical claims processing.

The position supports the claims team with routine processing, documentation, and confidentiality of PHI in a fast-paced remote work setting.

Qualifications

• Must have understanding of insurance processes (Medicare/Medicaid/Commercial).
• Two years of medical claims processing experience preferred.
• Knowledge of EOBs, CPT & ICD-10 codes.

Responsibilities

• Process claims per day per HCFA1500/UB92 guidelines.
• Review processed/pended claims with supervisor for accuracy and timeliness.
• Coordinate with supervisor on resolution of customer inquiries within 24 hours.
• Assist with claims adjustment projects as requested.
• May assist with claims entry when needed.
• Maintain confidentiality of PHI and follow HIPAA/policy requirements.

Skills

Insurance knowledge

Claims processing

HIPAA compliance

Analytical thinking

Communication skills

Education

High School Diploma or equivalent

Job description

Job Details

Job Location: Any Location Remote US - Oklahoma City, OK 73102, Position Type: Full Time, Education Level: High School or Equivalent, Travel Percentage: None, Job Shift: Day, Job Category: Admin - Clerical

WHO WE ARE

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

WHO YOU ARE

The Claims Processor is primarily responsible for processing all types of contracted and non-contracted claims accurately and timely for Medicare, Medicaid and Commercial Insurance products. The Claims Processor works directly with the Team Leader and/or Claims Supervisor on the day-to-day operations of the Claims for the purpose of meeting the company, department and regulatory standards for quantity, quality, and timeliness. This position requires the ability to work independently, accomplish goals, excellent customer service and communication skills.

ESSENTIAL JOB FUNCTIONS

• Processes claims based on the productivity and quality standard set (HCFA1500 and UB92) per day in accordance with contractual and non-contractual agreements and processing guidelines.
• Works with Claims Supervisor or Manager in review of processed and pended claims to ensure appropriate, timely and accurate claims processing.
• Coordinates with Claims Manager on resolution of customer service inquiries within 24 hours of receipt.
• Assist with Claims adjustment projects as requested.
• May help with Claims entry when requested.
• Completes various work assignments as requested by supervisor in a timely manner.
• Maintains current desk procedures and reference materials.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned.

EDUCATION AND EXPERIENCE

• High school diploma or equivalent required.
• Two year of medical claims processing experience strongly preferred.

KNOWLEDGE, SKILLS AND ABILITIES

• Must have full understanding of insurance processes (Managed Care, Medicare, Medicaid and Commercial practices).
• Working knowledge of medical claims processing guidelines and practices.
• Knowledge of Medicare and Health Care Finance Administration regulations.
• Knowledge of EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs and authorizations/referrals.
• Ability to read and interpret provider contracts.
• Strong verbal, written and organizational skills, must be self-directed/self-motivated and must have analytical, problem-solution, and decision-making abilities.
• Accurate keyboard skills.
• Ability to function in a fast-paced, detail-oriented environment.
• Basic math skills.
• High degree of accuracy.
• Team player.

WORK ENVIRONMENT

• Current work environment is remote, however, some state exclusions apply.
• Must have access to a reliable and secured internet connection source.
• Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.

TRAVEL

No travel is required.

SUPERVISORY RESPONSIBILITY

This position has no supervisory responsibility.

OTHER DUTIES

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.