Medical Claims Processor

CTC; Mason (OH); On-site; USD 42,000 - 56,000; Full time

Job summary

CTC in Mason, OH is seeking a claims processor who accurately and efficiently handles manual claims and other simple processing projects. You will apply basic knowledge of claims adjudication and adapt to changes in plans or benefit designs.

Collaborate with Account Managers, Operations, and leadership to deliver strong customer service, meet performance standards, and develop self-remediation when needed.

Responsibilities

• Processing - Efficiently and accurately processes standard claims or adjustments
• Consistently achieves key internals with respect to production, cycle time, and quality
• May participate on non-complex special claims projects initiatives, including network efforts
• Understands and quickly operationalizes processing changes resulting from new plans, benefit designs.
• Drive client satisfaction - Works with supervisor and co-workers to provide strong customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team
• Drives Key Performance Indications - Consistently meets or exceeds agreed upon performance standards in both productivity and accuracy
• Proactively works with supervisor to develop self-remediation plan when standards are not being met

Job description

GENERAL FUNCTION: Accurately and efficiently processes manual claims and other simple processes such as claims projects. Through demonstrated experience and knowledge, process standard, non-complex claims requiring a basic knowledge of claims adjudication.

MAJOR DUTIES & RESPONSIBILITIES:

• Processing - Efficiently and accurately processes standard claims or adjustments
• Consistently achieves key internals with respect to production, cycle time, and quality
• May participate on non-complex special claims projects initiatives, including network efforts
• Understands and quickly operationalizes processing changes resulting from new plans, benefit designs.
• Drive client satisfaction - Works with supervisor and co-workers to provide strong customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team
• Drives Key Performance Indications - Consistently meets or exceeds agreed upon performance standards in both productivity and accuracy
• Proactively works with supervisor to develop self-remediation plan when standards are not being met