Claims Processor I

Magellan Health; United States; On-site; USD 34,000 - 51,000; Full time

Job summary

Magellan Health in the United States is seeking a Claims Processor I to ensure accurate and timely processing of claims in accordance with policy and contractual terms.

You will adjudicate claims, resolve edits, maintain reference materials, and provide backup support to teammates while navigating ICD-9 and CPT coding requirements.

Qualifications

• Education required: GED or High School diploma.
• Work experience required: claims processing.
• Proficient with 10-key data entry.
• Experience with ICD-9 and CPT codes.

Responsibilities

• Adjudicates claims and adjustments.
• Resolves edits and suspended claims.
• Maintains reference materials for adjudication.
• Provides backup support to team members.

Skills

Attention to detail

Education

GED or High School Diploma

Tools

10-key machine

Job description

Responsible and accountable for the accurate and timely processing of all claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.

• Adjudicates claims and adjustments as required.
• Resolves claims edits and suspended claims.
• Maintains and updates required reference materials to adjudicate claims.

Provides backup support to other team/group members in the performance of job duties as assigned.

The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description.

Other Job Requirements

Ability to quickly use a 10-key machine.

Experience with list of ICD-9 codes and Current Procedural Terminology (CPT).

General Job Information

Title: Claims Processor I

Grade: 18

Work Experience - Required: Claims

Education - Required: GED, High School

Salary Range

• Salary Minimum: $34,295
• Salary Maximum: $51,445

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.

This position may be eligible for short-term incentives as well as a comprehensive benefits package. Magellan offers a broad range of health, life, voluntary and other benefits and perks that enhance your physical, mental, emotional and financial wellbeing.

Magellan Health, Inc. is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their position; and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.