Medical Insurance Claims Specialist

Peak Health; United States; À distance; USD 38 000 - 46 000; Plein temps

Résumé du poste

PHH Holdings is seeking a Claims Processor to join our PHH Claims Operations team in the United States. You will determine accuracy of claim information, verify data, resolve edits, and review payment levels to ensure correct benefit payments.

The role requires attention to detail, the ability to navigate multiple systems, and clear written and verbal communication with internal and external staff. Experience with medical claims processing and EPIC is preferred.

Qualifications

• High School diploma or GED with 1 year of claims data entry or customer service experience.
• Associate degree in related healthcare field preferred.
• Two plus years of medical or institutional claims processing and customer service experience.

Responsabilités

• Verify accuracy and completeness of claim information.
• Resolve claim edits, review history, determine benefit eligibility.
• Review payment levels to determine final payment.
• Meet production and quality standards and manage work queues.
• Communicate effectively with internal and external staff.
• Escalate issues to supervisor when appropriate.
• Ensure data entry accuracy and record maintenance.
• Attend required training classes and demonstrate learning.
• Perform other duties as assigned by Claims Manager.

Connaissances

Clerical procedures

Multi-system navigation

Written and oral communication

Problem solving

Medical math for adjudication

Medical insurance knowledge

Medical terminology knowledge

Attention to detail

Formation

High School diploma

Associate Degree in related healthcare field

Outils

Microsoft Office Suite

EPIC

Description du poste

PHH Holdings is seeking a Claims Processor to join our PHH Claims Operations team in the United States. You will determine accuracy of claim information, verify data, resolve edits, and review payment levels to ensure correct benefit payments.

The role requires attention to detail, the ability to navigate multiple systems, and clear written and verbal communication with internal and external staff. Experience with medical claims processing and EPIC is preferred.