Healthcare Claims Technician: Complex Claims & Resolution

Health Care Service; United States; Hybrid; USD 20,000 - 29,000; Full time

Job summary

Health Care Service Corporation is seeking a Claims Technician to process complex healthcare claims, investigate discrepancies, and ensure accurate adjudication in line with policies and regulations. The role requires attention to detail and strong analytical skills, with onboarding through mandatory onsite training.

The position is based in Albuquerque, NM, with remote work provisions established after successful completion of training.

Qualifications

• High school diploma or GED required.
• Strong data entry and typing ability.
• Proficiency with Microsoft Office, especially Excel for review and reporting.
• Clear, concise written and verbal communication skills.
• Experience processing medical claims with high-volume workload and quality metrics.

Responsibilities

• Process complex healthcare claims in various queues and adjudicate timely and accurately.
• Investigate and resolve pended or disputed claims and adjustments.
• Coordinate with plans, providers, and members to resolve issues.
• Research other coverage (Medicare/Medicaid) and update patient files as needed.
• Maintain knowledge of medical terminology and CPT/HCPCS/ICD9 coding.

Skills

Data entry

Attention to detail

Analytical thinking

Communication skills

Education

High School diploma or GED

Tools

Microsoft Office Suite

Excel

Job description

Health Care Service Corporation is seeking a Claims Technician to process complex healthcare claims, investigate discrepancies, and ensure accurate adjudication in line with policies and regulations. The role requires attention to detail and strong analytical skills, with onboarding through mandatory onsite training.

The position is based in Albuquerque, NM, with remote work provisions established after successful completion of training.