Claims Processor II: Accurate Adjudication & Timely Pay

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

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