Medical Claims Processor

ttg Talent Solutions, Inc.; Town of Florida (NY); On-site; USD 29,000 - 32,000; Full time

Job summary

ttg Talent Solutions, Inc. seeks a detail-oriented Medical Claims Processor (Claims Examiner I) to process Medicare and DSNP healthcare claims in a managed care setting.

This on-site role in Doral, FL is full-time, 40 hours weekly, with potential weekends/holidays as needed and a pay rate of $21–$23 per hour. The ideal candidate has 2–4 years in healthcare or managed care claims processing, strong Medicare knowledge, and experience with disputes, COB, coding, and reimbursement; high attention to

Qualifications

• 2–4 years of healthcare or managed care claims processing experience.
• Strong knowledge of Medicare and DSNP claims.
• Experience with claims adjudication, reprocessing, disputes, appeals, and COB.
• Familiarity with CPT, HCPCS, and ICD-10 coding.
• Understanding of provider contracts, fee schedules, and reimbursement.
• Strong analytical, organizational, and problem-solving skills.
• High attention to detail; ability to work in a fast-paced environment.

Responsibilities

• Review, adjudicate, and reprocess Medicare and DSNP claims accurately.
• Handle disputes, reconsiderations, appeals, and claim adjustments.
• Apply benefits, COB, coding edits, provider contracts, and fee schedules.
• Ensure compliance with CMS, state regulations, and internal policies.
• Identify and escalate complex claims or system issues.
• Maintain accuracy, productivity, documentation, and turnaround standards.
• Collaborate with internal teams to resolve claim-related issues.

Skills

Healthcare claims processing

Medicare knowledge

DSNP

Disputes & appeals

CPT coding

HCPCS coding

ICD-10 coding

Provider contracts

Fee schedules

CMS regulations

Audits

Dual-eligible populations

Medicare Part C

Analytical skills

Attention to detail

Documentation

Education

High School Diploma

College degree preferred

Job description

Medical Claims Processor

Location: Doral, FL on-site

Schedule: Full-Time | 40 hours per week; schedule may vary based on business needs, including occasional weekends, holidays, and overtime

Type of Contract: Full-Time

Pay Rate: $21 - $23.00 per hour

Description

We are seeking a detail-oriented Claims Examiner I to process and adjudicate healthcare claims, primarily Medicare and DSNP, within a managed care environment. The ideal candidate has healthcare claims experience, strong Medicare knowledge, and experience with disputes, appeals, COB, coding, and reimbursement.

Responsibilities

• Review, adjudicate, and reprocess Medicare and DSNP claims accurately.
• Handle disputes, reconsiderations, appeals, and claim adjustments.
• Apply benefits, COB, coding edits, provider contracts, and fee schedules.
• Ensure compliance with CMS, state regulations, and internal policies.
• Identify and escalation complex claims or system issues.
• Maintain accuracy, productivity, documentation, and turnaround standards.
• Collaborate with internal teams to resolve claim-related issues.

Requirements

• High school diploma or equivalent; college degree preferred.
• 2–4 years of healthcare or managed care claims processing experience.
• Strong knowledge of Medicare and DSNP claims.
• Experience with claims adjudication, reprocessing, disputes, appeals, and COB.
• Familiarity with CPT, HCPCS, and ICD-10 coding.
• Understanding of provider contracts, fee schedules, and reimbursement.
• Strong analytical, organizational, and problem-solving skills.
• High attention to detail and ability to work in a fast-paced environment.

Preferred

• Knowledge of CMS regulations and audits.
• Experience with dual-eligible populations and Medicare Part C.

At ttg, "We believe in making a difference One Person at a Time," ttg OPT.