Health Plans Claims Processor

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

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position for use in University of Utah Health Plans only. The Claims Processor position is responsible for following manual processes to finalize claims while optimizing efficiency, service and quality. This position is not responsible for providing care to patients.

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Responsibilities

Essential Functions

• 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.

Knowledge / Skills / Abilities

• 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.

Qualifications

Required

• One year of experience as a medical claims processor, or equivalent.

Qualifications (Preferred)

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Listening, Sitting, Speaking, Standing, Walking

Multi-lingual Candidates Welcomed

EEO Statement

University of Utah Health Hospitals and Clinics, a part of The University of Utah, values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patient populations.

All qualified individuals are encouraged to apply. Veterans’ preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities.

University of Utah Health Hospitals and Clinics, a part of The University of Utah, is an Affine Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran's status. The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106. The requirement not to discriminate in education programs or activities extends to admission and employment. Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both.

To request a reasonable accommodation for a disability, please contact the University of Utah Health Hospitals and Clinics Human Resources office at 801-581-6500. If you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity (OEO). More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at: www.utah.edu/nondiscrimination/
Online reports may be submitted at oeo.utah.edu/

The University is a participating employer with Utah Retirement Systems(“URS”). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work). Contact Hospitals and Clinics Human Resources at [phone] for information. Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS’ post-retirement rules and restrictions. Please contact Utah Retirement Systems at [phone] or [phone] or Hospitals and Clinics Human Resources at [phone] if you have questions regarding the post-retirement rules.

This position may require the successful completion of a criminal background check and/or drug screen.

Requisition Number 86314
Reg/Temp Regular
Employment Type Full-Time
Shift Day
Work Schedule 630am-6pm determined with Supervisor
Location Name University of Utah Health Plans
Workplace Set Up Hybrid
City Murray
State UT
Department UIP CST 01H UUHP OPERATIONS
Category Health Plans
Workplace Set Up Hybrid