Claims Processor II

Magellan Health; United States; On-site; USD 37,000 - 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 all claims in accordance with policies and contracts. You will adjudicate claims and adjustments, resolve edits, and maintain reference materials.

The role requires navigating computer systems, knowledge of ICD-9/10 and CPT, strong analytical abilities, and clear written and verbal communication. Salary is listed, with comprehensive benefits and incentives, reflecting a national role in the United States.

Qualifications

• Proficient in navigating computer applications and systems.
• Experience with ICD-9/10 codes and CPT terminology.
• Strong analytical and problem-solving abilities.
• Clear written and verbal communication skills.
• Ability to read, interpret directions, and follow procedures.

Responsibilities

• Process claims accurately and in a timely manner.
• Adjudicate claims and adjustments as required.
• Resolve edits and suspended claims.
• Maintain and update reference materials for adjudication.
• Provide backup support to team members as needed.
• Collaborate with Quality on procedures and feedback.

Skills

Computer skills

ICD-10/CPT codes

Analytical skills

Written & oral comms

Reading comprehension

Education

GED or 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.

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 Work Experience - Preferred
• Education - Required GED, High School Education
• Education - Preferred
• License and Certifications - Required
• License and Certifications - Preferred
• Salary Range Salary Minimum: $37,725
• Salary Range Salary Maximum: $56,595

Salary Information

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.

Benefits and Perks

• 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.

Magellan is the employer of choice for hard working people interested in making a difference in the health care industry and in the communities where we work and live.

Our strong culture of caring is the common thread in both our business strategy and our work environment.

We value professional growth and development, total health and wellness, rewards and recognition as well as employee unity.

Magellan is committed to providing equal employment opportunities to employees and applicants for employment without regard to race, color, creed, religion, sex, gender identity and expression, sexual orientation, marital status, age, national origin, ancestry, citizenship, physical or mental disability, disabled veteran or veteran of the Vietnam Era status, or any other factors protected by law.

Magellan is committed to meeting applicable Federal labor and employment law posting requirements by providing necessary posters in a format which is easily accessible and conspicuous to all applicants. Copies of applicable posters are accessible by clicking here.