Medical Claims Processor

Ztek Consulting; Iowa (LA); On-site; USD 40,000 - 70,000; Part time

Job summary

Ztek Consulting is seeking a Claims Processing Executive for a contract, remote role in the US healthcare sector. You will leverage MS Excel to manage and process commercial claims, with responsibilities spanning validation, adjudication, and reporting to improve accuracy and efficiency.

You'll work with HIPAA-compliant processes, review payer guidelines, and ensure timely processing of claims for Medicare, Medicaid, and commercial payers.

Qualifications

• High school diploma or equivalent required.
• 2–4 years of US healthcare claims processing experience.
• Strong knowledge of Medicare, Medicaid, and commercial payers.
• Familiarity with claims management software and EDI transactions.
• Excellent analytical, organizational and communication skills.
• Ability to interpret insurance policies and payer guidelines.
• Regulatory knowledge of US healthcare laws and payer requirements.
• Accurate and detail-oriented; resolves disputes effectively.

Responsibilities

• Review, validate, and process healthcare claims.
• Verify patient eligibility and pre-authorization requirements.
• Adjudicate claims based on payer guidelines and policy terms.
• Maintain HIPAA compliance and prepare management reports.
• Record claim activity and keep audit trails.

Skills

Analytical

Organizational

Communication

Detail-oriented

Problem-solving

Regulatory knowledge

Education

High school diploma or equivalent

Tools

QNXT

EDI transactions

Claims management software

Job description

Role: Contract

Job Description/Responsibilities:

Join our team as a Claims Processing Executive in the healthcare sector where you will utilize your expertise in MS Excel to efficiently manage and process commercial claims. This remote position offers the flexibility of working from home during day shifts allowing you to balance work and personal commitments effectively. Your contributions will directly impact the accuracy and efficiency of our claims processing, enhancing customer satisfaction and operational excellence.

Key Responsibilities-

• Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
• Core platform – QNXT claims experienced -Required
• Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
• Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
• Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
• Documentation: Record claim activity, maintain audit trails, and prepare reports for management.

Required Skills & Qualifications-

• High school diploma or equivalent REQUIRED
• Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers).
• 2–4 years of experience in US healthcare claims processing
• Familiarity with claims management software and EDI transactions.
• Excellent analytical, organizational, and communication skills.
• Ability to interpret insurance policies and payer guidelines.
• Detail-oriented with strong problem-solving abilities.
• Regulatory Knowledge – Deep understanding of US healthcare laws and payer requirements.
• Accuracy & Detail Orientation – Ensures claims are processed correctly and efficiently.
• Prodblem-Solving – Resolves claim disputes and denials effectively.