Healthcare Claims Specialist | Precision & Compliance

Correctional Health Partners, LLC; Denver (CO); On-site; USD 32,000 - 37,000; Full time

Benefits offered by this job

401(k) plan

Medical, dental, and vision benefits

Flex spending, medical, dependent care

Paid time off 28 days/year

11 paid holidays

Tuition reimbursement

Job summary

Correctional Health Partners, LLC is seeking a Claims Examiner to process provider and facility claims, verify eligibility, and adjudicate within QA standards. You will collaborate with departments, provide process feedback, and handle inquiries in a healthcare-focused environment.

Applicants should bring 3–5 years in managed healthcare and strong knowledge of CPT/ICD-10/HCPC coding, HIPAA compliance, and claims systems proficiency. Competitive benefits offered.

Qualifications

• High School Diploma/GED.
• Three to five years’ experience working in a managed healthcare environment.
• Minimum of two years of combined experience processing healthcare claims/appeals or adjudication.
• Knowledge of medical terminology, CPT/ ICD-10/HCPC coding, and EOB/EOP interpretation.
• Proficiency in claims processing systems.
• Attention to detail and accuracy.
• Time management and prioritization.
• Critical thinking and decision-making.
• Written and verbal communication.
• Team collaboration and adaptability.
• Understanding of HIPAA and confidentiality protocols.
• Must adhere to CHP’s five core values: Integrity, Teamwork, Accountability, Patient-centered, Compassion.

Responsibilities

• Process provider and facility claims according to the fee schedule/rates specified within the provider’s contracts.
• Verify eligibility and authorization prior to adjudication.
• Manage workflow to maintain turnaround time requirements.
• Adjudicate claims within Quality Assurance standards.
• Collaborate with other departments in refining/improving processes.
• Provide feedback to the supervisor on trends and issues observed as opportunities for process improvement.
• Provide customer service for incoming and outgoing inquiries.

Skills

Attention to detail

Time management

Critical thinking

Written communication

Verbal communication

Team collaboration

HIPAA knowledge

Education

High School Diploma/GED

Tools

Claims processing systems

Job description

Correctional Health Partners, LLC is seeking a Claims Examiner to process provider and facility claims, verify eligibility, and adjudicate within QA standards. You will collaborate with departments, provide process feedback, and handle inquiries in a healthcare-focused environment.

Applicants should bring 3–5 years in managed healthcare and strong knowledge of CPT/ICD-10/HCPC coding, HIPAA compliance, and claims systems proficiency. Competitive benefits offered.