Claims Processor II

Magellan Health; United States; On-site; USD 38,000 - 57,000; Full time

Benefits offered by this job

Short-term incentives

Comprehensive benefits package

Job summary

Magellan Health is seeking a Claims Processor II in the United States. The role focuses on accurate and timely processing of claims, adherence to payment policies, and compliance with contractual terms. You will adjudicate, price, and resolve claims while maintaining updated reference materials.

You'll collaborate with the Quality team, receive coaching from leadership, and provide backup support to teammates as needed. GED or high school education is required.

Qualifications

• Demonstrated ability to navigate computer applications.
• Experience with ICD-9/10 codes and CPT.
• Demonstrated basic analytical skills.
• Basic written and oral communication skills.
• Demonstrated reading comprehension and ability to follow provided directions.

Responsibilities

• 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 members as assigned.
• Manually prices claims with various tools and processes.
• Analyzes updated materials to adjudicate claims and provides feedback when needed.
• Partners with the Quality team for clarity on procedures and complex claims.

Skills

Computer navigation

ICD-9/10 & CPT knowledge

Analytical skills

Written & oral communication

Reading comprehension

Education

GED

High School Diploma

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.
• Manually prices claims with various tools and processes to pay the claims.
• Utilizes reference materials and analyzes updated materials to adjudicate claims. This includes reviewing material updates daily and sharing feedback or suggestions if any concerns arise.
• Partners with the Quality team for clarity on procedures and complex claims and receives coaching from leadership.

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

• Demonstrated ability to navigate computer applications.
• Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT).
• Demonstrated basic analytical skills.
• Basic written/oral communication skills.
• Demonstrated reading comprehension and ability to follow provided directions.

General Job Information

Title

Claims Processor II

Grade

19

Work Experience - Required

Claims

Education - Required

GED, High School

Salary Range

Salary Minimum

$37,725

Salary Maximum

$56,595

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.