Claims Processor

Location: Rancho Cordova
Posted on: November 20, 2024

Job Description:

This Claims Processor Position Features:

JOB SUMMARY:

The position requires the ability to work in a high volume medical claims environment including daily processing of various types of claims with 200+ claims paid on average per day basis with 98.5% accuracy. The various types of claims include PPO, ASO, Medicare, Patient Pays and COB.

DUTIES AND ACCOUNTABILITIES:

?Processing of various types of medical claims

?Knowledge of CPT and HCPCS codes

?Knowledge of medical claim payment systems

?Knowledge of HIPPA Compliance and its importance in the insurance and medical industry.

?Demonstrated knowledge of claims batch oversight

?Ability to interface effectively with Providers

?Perform other related duties as assigned

QUALIFICATIONS/ REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Experience:

Three plus years claims processing (medical, dental and/or vision) area is required. Knowledge of provider reimbursements and experience in the vision insurance industry would be preferred.

Knowledge/Skills:

?Excellent interpersonal and presentation skills

?Understanding of Managed Care in the Healthcare industry

?Timely and thorough problem resolution skills

?Team orientation and ability to work effectively across functional areas of the company

?Strong organizational skills and the ability to be resourceful in problem solving.

?Ability to coordinate multiple tasks/projects

?Strong communication skills - written and verbal

?Strong analytical abilities and demonstrated use of good judgment

?Ability to work independently utilizing company established processes

?Strong execution and follow-up skills

?Ability to meet deadlines

?Strong computer skills including Excel and Microsoft Word

?Good working knowledge of claims adjudication systems

?Goal oriented with ability to meet production standards

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

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