Health Plans Claims Processor

University of Utah Health; Salt Lake City (UT); On-site; USD 42,000 - 64,000; Full time

Job summary

University of Utah Health Plans seeks a Claims Processor to finalize claims, adjudicate deductibles, co-pays and reimbursements, and ensure accurate, timely payments in a patient-focused environment.

You will enter claims data, interpret medical terminology related to diagnoses and procedures, support system testing during upgrades, and collaborate with the claims team to meet performance goals.

Qualifications

• One year of experience in medical claims processing or equivalent.
• Experience with claims processing in a health care setting or with insurance payers preferred.

Responsibilities

• Supports and promotes the health plan's mission and goals.
• Enters claims data into the system and interprets coding and medical terminology.
• Processes claim forms and adjudicates deductibles, co-pays, co-insurance maximums, and provider reimbursements.
• Follows adjudication policies to ensure proper payment of claims.
• Assists in testing system functionality during upgrades and implementations.

Skills

Claims processing

Healthcare payer

Teamwork

Organization

Communication

Medical terminology

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.

Required

Qualifications

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

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