Sr Claims Processor

Summa Health; Akron (OH); Hybrid; USD 58,768,000 - 70,657,000; Full time

Benefits offered by this job

Life Insurance

AD&D and Dependent Life

Disability Insurance (Short/Long Term)

Accident Insurance

Hospital Indemnity

Critical Illness Insurance

Retirement Plan

Flex Spending Accounts

EAP

Identity Theft Protection

Pet Insurance

Education Assistance

Daily Pay

Job summary

SummaCare in Akron, OH seeks a full-time claims processor to handle health insurance claims accurately and on time. You will review coordination of benefits, medical coding, authorizations, and sub-system updates, applying cost-containment strategies with vendors.

The role involves repricing reconciliation, case agreement processing, and mentoring junior processors as needed. Basic Word/Excel, CPT/HCPCS/ICD-10 knowledge, and CMS1500/UB-04 understanding are required.

Qualifications

• High School Diploma or equivalent.
• Two (2) years performing same or similar responsibilities.
• Health insurance claims processing knowledge.

Responsibilities

• Responsible for the accurate and timely handling of claims in accordance with regulatory and contractual guidelines.
• Reviews claims related to coordination of benefits, medical coding, and authorization assignments.
• Applies cost-containment techniques when working with vendor partners to minimize claim costs while ensuring adherence to rules.
• Repricing reconciliation and case-claim processing.

Skills

Claims processing

DMS data entry

Customer service

Medical billing

Patient accounts

Word basics

Excel basics

Medical terminology

CPT/HCPCS/ICD-10

CMS1500 UB-04

Detail orientation

Analytical skills

Patient interaction

Education

High School Diploma or equivalent

Tools

DMS

Job description

Position Information

Location: SummaCare - 1200 E Market St, Akron, OH (Remote after training)

Classification: Full-Time / 40 Hours / Days

Salary: $20.51/hr - $24.61/hr

Summary

Responsible for the accurate and timely handling of claims in accordance with regulatory and contractual guidelines. Reviews claims related to coordination of benefits, medical coding, authorization assignments, and necessary sub-system updates. Applies cost-containment techniques when working with vendor partners to minimize claim costs while ensuring adherence to plan-specific and line-of-business processing rules. Responsibilities include, but are not limited to, repricing reconciliation and case agreement claim processing. May mentor junior processors to support team development.

Formal Education Required

• High School Diploma or equivalent

Experience & Training Required

Two (2) years performing same or similar responsibilities.

• health insurance claims processing
• health claims data entry including Document Management Services (DMS)
• customer service experience in a managed care environment
• physician or hospital billing
• patient accounts

Other Skills, Competencies and Qualifications

• Word and Excel at a basic level. Must achieve passing score on test administered by Human Resources.
• Skilled in medical terminology, CPT, HCPCs, and ICD-10
• Understanding of professional (CMS1500) and institutional (UB-04) claim types
• Health claims processing knowledge
• Close attention to detail with independent judgment, decision making and problem solving skills
• Strong analytical skills with the ability to interpret complex data sets and draw meaningful conclusions
• Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity

Level of Physical Demands

• Sit for prolonged periods of time
• Bend, stop and stretch
• Lift up to 20 pounds
• Manual dexterity to operate computer, phone and standard office machines

Equal Opportunity Employer/Veterans/Disabled

The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

Benefits

• Basic Life and Accidental Death & Dismemberment (AD&D)
• Supplemental Life and AD&D
• Dependent Life Insurance
• Short-Term and Long-Term Disability
• Accident Insurance, Hospital Indemnity, and Critical Illness
• Retirement Savings Plan
• Flexible Spending Accounts – Healthcare and Dependent Care
• Employee Assistance Program (EAP)
• Identity Theft Protection
• Pet Insurance
• Education Assistance
• Daily Pay

Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.