Claims Processor - Remote / Telecommute

Cynet Systems Inc; Los Angeles (CA); Remote; USD 10,000 - 60,000; Full time

Job summary

A prominent company in healthcare services is seeking a Claims Processor to handle non-adjudicated claims. The successful candidate will conduct in-depth research and ensure timely processing of claims. Requires strong analytical skills and 3 years of relevant experience. Join a dynamic environment with opportunities for growth.

Qualifications

• 3 years claims experience required.
• Experience in medical claims processing preferred.

Responsibilities

• Examine and resolve non-adjudicated claims based on contracts and policies.
• Conduct extensive research for procedures and assist customer service reps.
• Complete daily productivity data for performance statistics.

Skills

Communication

Analytical skills

Claims systems knowledge

Reading comprehension

Customer service

Education

High School Diploma or GED

Tools

FACETS Claims processing application

Job description

Job Description:

Pay Range: $17.85hr - $22.85hr

Essential Functions:

• 55% 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 use 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% Does extensive research of procedures.
• May also apply training materials, emails and medical policy to ensure claims are processed correctly.
• Utilizes the quality team for assistance on unclear procedures and/or difficult claims and receives coaching from leadership.
• Ongoing developmental training to performing daily functions.
• 10% Completes productivity data daily that is used by leadership to compile performance statistics.
• Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design, financial planning, etc.
• 10% Assists Customer Service Reps by 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.
• High School Diploma or GED.
• 3 years claims experience required.

Preferred Qualifications:

• Three years medical claims processing, billing or medical terminology experience. Experience using the FACETS Claims processing application.

Knowledge, Skills and Abilities:

• Demonstrated communication skills both written and verbal.
• Demonstrated strong analytical skills.
• Demonstrated knowledge and understanding of claims systems and processes.
• Demonstrated reading comprehension of materials provided to adjudicate claims.
• The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs.
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.