Remote Claims Processor III – Complex Claims Specialist

Premera; Washington; On-site; USD 45,000 - 77,000; Full time

Benefits offered by this job

Medical, vision, and dental coverage

401K employer match

Tuition assistance

Paid time off

On-site parking and resources

Job summary

Premera is hiring a Claims Processor III to review, research, and resolve moderate to complex claims across Medicare, DSHS, subrogation, and coordination of benefits for dental, medical and hospital claims. You will act as a technical resource, train trainees, and ensure accuracy and timely resolution while maintaining confidentiality.

Requirements include a high school diploma or GED and at least one year of claims processing or customer service experience, plus knowledge of out-of-area

Qualifications

• High School diploma or GED required.
• 1 year claims processing or customer service experience required.
• Understanding of out-of-area programs and in-team audit experience.

Responsibilities

• Review, research, and resolve claims in accordance with contracts and policies.
• Identify COB, subrogation, and general inquiry issues and communicate results.
• May complete claim adjustments, reversals and refunds.
• Act as the team technical subject matter expert including training and auditing trainees.
• Keep reference materials updated.
• Develop and maintain relationships with internal and external customers via written and verbal communications.
• Prepare formal history reviews.
• Meet cycle time/productivity goals aligned with corporate objectives.
• Maintain confidentiality of all documents/files.
• Translate data into information acceptable to the claims processing system.
• Apply commitment to quality by doing things right the first time to avoid defects.

Skills

Claims processing

Customer service

Audit experience

Out-of-area programs

Education

High School diploma or GED

Job description

Premera is hiring a Claims Processor III to review, research, and resolve moderate to complex claims across Medicare, DSHS, subrogation, and coordination of benefits for dental, medical and hospital claims. You will act as a technical resource, train trainees, and ensure accuracy and timely resolution while maintaining confidentiality.

Requirements include a high school diploma or GED and at least one year of claims processing or customer service experience, plus knowledge of out-of-area