Precision Claims Adjudicator II

Magellan Health; United States; On-site; USD 38,000 - 57,000; Full time

Benefits offered by this job

Short-term incentives

Comprehensive benefits package

Job summary

Magellan Health is seeking a Claims Processor II in the United States. The role focuses on accurate and timely processing of claims, adherence to payment policies, and compliance with contractual terms. You will adjudicate, price, and resolve claims while maintaining updated reference materials.

You'll collaborate with the Quality team, receive coaching from leadership, and provide backup support to teammates as needed. GED or high school education is required.

Qualifications

• Demonstrated ability to navigate computer applications.
• Experience with ICD-9/10 codes and CPT.
• Demonstrated basic analytical skills.
• Basic written and oral communication skills.
• Demonstrated reading comprehension and ability to follow provided directions.

Responsibilities

• Adjudicates claims and adjustments as required.
• Resolves claims edits and suspended claims.
• Maintains and updates required reference materials to adjudicate claims.
• Provides backup support to other team members as assigned.
• Manually prices claims with various tools and processes.
• Analyzes updated materials to adjudicate claims and provides feedback when needed.
• Partners with the Quality team for clarity on procedures and complex claims.

Skills

Computer navigation

ICD-9/10 & CPT knowledge

Analytical skills

Written & oral communication

Reading comprehension

Education

GED

High School Diploma

Job description

Magellan Health is seeking a Claims Processor II in the United States. The role focuses on accurate and timely processing of claims, adherence to payment policies, and compliance with contractual terms. You will adjudicate, price, and resolve claims while maintaining updated reference materials.

You'll collaborate with the Quality team, receive coaching from leadership, and provide backup support to teammates as needed. GED or high school education is required.