Medical Claims Processor

nTech Workforce; United States; Remote; USD 1,000; Full time

Job summary

A leading workforce provider is seeking a Claims Processor to join their team. This fully remote position involves reviewing and adjudicating medical claims, ensuring compliance with policies, and collaborating across departments. Ideal candidates will have extensive claims processing experience and strong analytical skills.

Qualifications

• 3+ years of experience processing claim documents.
• Adjudicated 200-300 medical claims daily with 98% accuracy.
• High attention to detail and excellent communication skills.

Responsibilities

• Examine and resolve non-adjudicated claims.
• Process product-specific claims for timely payments.
• Collaborate with departments providing feedback and resolving issues.

Skills

Analytical skills

Communication skills

Attention to detail

Education

High School Diploma or GED

Tools

Microsoft Outlook

Microsoft Excel

Adobe Acrobat

Job description

This range is provided by nTech Workforce. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$23.00/hr - $23.00/hr

Direct message the job poster from nTech Workforce

Pay Rate: $23.20/hour on W2 - All inclusive

Terms of Employment

• This position is fully remote. Candidates must be based in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas.

• This is a full-time position, 40 hours per week.

Overview

Our client is seeking a Claims Processor to review and adjudicate paper/electronic claims. Claims Processors will determine proper handling and adjudication of claims following organizational policies and procedures.

Responsibilities

• Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures.

• Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims.

• Use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.

• Completes research of procedures.

• Applies training materials, correspondence and medical policies to ensure claims are processed accurately.

• Partners with the Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership.

• Participate in ongoing developmental training to perform daily functions.

• Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.

• Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

Required Skills & Experience

• High School Diploma or GED and 3+ years of experience processing claim documents.

• Previously adjudicated 200-300 medical claims daily with accuracy of 98% or above for prior roles.

• Demonstrated analytical skills.

• Demonstrated reading comprehension and ability to follow directions provided.

• Excellent written/oral communication skills.

• Demonstrated ability to navigate computer applications, namely, Microsoft Outlook, Excel, and Adobe Acrobat.

• High attention to detail.

Preferred Skills & Experience

• 5+ years Claims processing, billing, or medical terminology experience.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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