Claims Processor II

magellanhealth; 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 to ensure accurate and timely processing of claims in line with policy and contractual terms. You will adjudicate, price, and resolve edits while maintaining reference materials and providing backup support to the team.

The role requires familiarity with ICD-9/10 codes and CPT, strong analytical skills, and clear written and verbal communication. Minimum education includes GED or high school, with opportunities to contribute to process

Qualifications

• Familiarity with ICD-9/10 codes and CPT for claims processing.
• Ability to navigate computer applications and adjudication systems.
• Strong analytical and numerical reasoning for claim pricing and adjustments.
• Clear written and verbal communication for documenting and explaining decisions.
• Good reading comprehension and ability to follow provided directions.

Responsibilities

• Process claims accurately and in a timely manner per policy and contracts.
• Adjudicate claims and adjustments; resolve edits and suspended claims.
• Maintain and update reference materials used to adjudicate claims.
• Provide backup support to team members as needed; collaborate with Quality.

Skills

ICD-9/10 codes

CPT coding

Analytical skills

Written and verbal communication

Reading comprehension

Education

GED/High School

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

Responsibilities

• 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

Work Experience - Preferred

Education - Required

GED, High School

Education - Preferred

License and Certifications - Required

License and Certifications - Preferred

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.