Health Plan Claims Specialist

Utah; Murray (UT); Hybrid; USD 42,000 - 56,000; Full time

Job summary

University of Utah Health Plans is seeking a Claims Processor to finalize and adjudicate medical claims. The role focuses on accurate data entry, applying coding concepts, and ensuring proper payment of claims within established policies.

The ideal candidate will have at least one year of claims processing experience in a healthcare or payer setting, strong organizational skills, and effective communication abilities. This hybrid position is based in Murray, UT.

Qualifications

• Ability to perform the essential functions of the job as outlined above.
• Experience with claims processing in a health care delivery setting or with insurance payers.
• Ability to work effectively, independently, and as part of a team.
• Strong organization, time management and project management skills and multi-tasking abilities.
• Detail oriented with problem-solving abilities.
• Demonstrates strong communication skills.

Responsibilities

• Supports and promotes University of Utah Health Plan's mission, vision, values, and goals.
• Contributes to positive and productive team environment.
• Maintains accountability for claim performance expectations.
• Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnoses and procedures.
• Processes claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements.
• Follows adjudication policies and procedures to ensure proper payment of claims.
• Assists in testing system functionality during system upgrades and implementations.

Skills

Claims processing

Healthcare experience

Teamwork

Organization & time management

Communication skills

Problem solving

Job description

University of Utah Health Plans is seeking a Claims Processor to finalize and adjudicate medical claims. The role focuses on accurate data entry, applying coding concepts, and ensuring proper payment of claims within established policies.

The ideal candidate will have at least one year of claims processing experience in a healthcare or payer setting, strong organizational skills, and effective communication abilities. This hybrid position is based in Murray, UT.