Medical Claims Processor: Policy & Payments Expert

Cynet Systems Inc.; Alaska; Remote; USD 42,000 - 56,000; Full time

Job summary

Cynet Systems Inc. is seeking a Claims Processor to examine, research, and resolve non-adjudicated claims ensuring accurate processing per medical policies, contracts, and procedures. This role collaborates across teams and uses multiple systems to maintain productivity and quality.

The position targets individuals with strong analytical skills, basic medical terminology, and solid computer navigation. Typical duties include calculating deductibles, pending claims, and producing daily

Qualifications

• High School Diploma or GED required.
• Less than one year of experience processing claim documents.
• Experience in claims processing, billing, or medical terminology preferred.

Responsibilities

• Examine and resolve non-adjudicated claims based on contracts and medical policies.
• Process product- or system-specific claims to ensure timely payments.
• Calculate deductibles and maximums and research pending claims.
• Use automated systems to pend claims accurately and in line with requirements.
• Research procedures and apply training materials to ensure accurate processing.
• Collaborate with Quality and leadership for clarification and coaching.
• Complete daily productivity reporting for leadership.
• Coordinate with multiple departments to resolve issues and answer questions.

Skills

Analytical skills

Reading comprehension

Written & oral communication

Computer navigation

Education

High School Diploma or GED

Job description

Cynet Systems Inc. is seeking a Claims Processor to examine, research, and resolve non-adjudicated claims ensuring accurate processing per medical policies, contracts, and procedures. This role collaborates across teams and uses multiple systems to maintain productivity and quality.

The position targets individuals with strong analytical skills, basic medical terminology, and solid computer navigation. Typical duties include calculating deductibles, pending claims, and producing daily