Claims Processor - Remote / Telecommute

Cynet Systems Inc; Fairfax (VA); Remote; USD 45,000 - 55,000; Full time

Job summary

Cynet Systems Inc is seeking a Claims Processor to examine and resolve non-adjudicated claims. The role requires analyzing claims to ensure payments, collaborating with departments for issue resolution, and participating in ongoing training. Candidates should have significant experience in claims processing and demonstrate strong analytical skills.

Qualifications

• More than three years experience processing claim documents.
• 5+ years claims processing or medical terminology experience.

Responsibilities

• Examine and resolve non-adjudicated claims and ensure timely payments.
• Complete research of procedures and apply training materials for accuracy.
• Collaborate with multiple departments to resolve issues.

Skills

Analytical skills

Reading comprehension

Basic communication skills

Computer navigation

Education

High School Diploma or GED

Job description

Job Description:

Essential Functions:

• 60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures.
• Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims.
• The Claims Processor also uses automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
• 25% Completes research of procedures.
• Applies training materials, correspondence and medical policies to ensure claims are processed accurately.
• Partners with the Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership.
• Required participation in ongoing developmental training to perform daily functions.
• 10% Completes productivity daily data that is used by leadership to compile performance statistics.
• Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
• 5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

Qualifications:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• The requirements listed below are representative of the knowledge, skill, and/or ability required.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Education Level: High School Diploma or GED.
• Experience: more than three years experience processing claim documents. Experience with processing Inter-Plan Teleprocessing System (ITS) Claims.
• 5+ years Claims processing, billing, or medical terminology experience.

Knowledge, Skills and Abilities:

• Demonstrated analytical skills Proficient.
• Demonstrated reading comprehension and ability to follow directions provided Proficient.
• Basic written/oral communication skills Proficient.
• Demonstrated ability to navigate computer applications Proficient.