Claims Processor - Remote / Telecommute

Cynet Systems Inc.; Alaska; Remote; USD 42,000 - 56,000; Full time

Job summary

Cynet Systems Inc. is seeking a Claims Processor to examine, research, and resolve non-adjudicated claims ensuring accurate processing per medical policies, contracts, and procedures. This role collaborates across teams and uses multiple systems to maintain productivity and quality.

The position targets individuals with strong analytical skills, basic medical terminology, and solid computer navigation. Typical duties include calculating deductibles, pending claims, and producing daily

Qualifications

• High School Diploma or GED required.
• Less than one year of experience processing claim documents.
• Experience in claims processing, billing, or medical terminology preferred.

Responsibilities

• Examine and resolve non-adjudicated claims based on contracts and medical policies.
• Process product- or system-specific claims to ensure timely payments.
• Calculate deductibles and maximums and research pending claims.
• Use automated systems to pend claims accurately and in line with requirements.
• Research procedures and apply training materials to ensure accurate processing.
• Collaborate with Quality and leadership for clarification and coaching.
• Complete daily productivity reporting for leadership.
• Coordinate with multiple departments to resolve issues and answer questions.

Skills

Analytical skills

Reading comprehension

Written & oral communication

Computer navigation

Education

High School Diploma or GED

Job description

The Claims Processor is responsible for examining, researching, and resolving non-adjudicated claims to ensure accurate and timely processing in accordance with medical policies, contracts, and procedures.

The role involves working across multiple systems, collaborating with internal teams, and maintaining productivity and quality standards.

Responsibilities:

• Examine and resolve non-adjudicated claims by identifying processing requirements based on contracts, medical policies, and procedures.
• Process product- or system-specific claims to ensure timely payment generation.
• Calculate deductibles and maximums and research and resolve pending claims.
• Utilize automated systems to pend claims for accurate completion in alignment with medical policy and contractual requirements.
• Research procedures and apply training materials, correspondence, and medical policies to ensure accurate claim processing.
• Partner with the Quality team for clarification on complex or difficult claims and receive coaching from leadership.
• Participate in ongoing developmental training to support daily functions.
• Complete daily productivity reporting used by leadership for performance tracking, workflow design, and planning.
• Collaborate with multiple departments to provide feedback, resolve issues, and answer basic processing questions.

Requirement/Must Have:

• High School Diploma or GED.

Experience:

• Less than one year of experience processing claim documents.

Should Have:

• Experience in claims processing, billing, or medical terminology.

Skills:

• Demonstrated analytical skills.
• Strong reading comprehension and ability to follow written directions.
• Basic written and oral communication skills.
• Proficiency in navigating computer applications.