Claims Processor

Terms of Employment Contract-to-Hire, 12 months This position is fully remote. Candidates must be based in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, Florida, or Texas. This is a full-time position, 40 hours per week. Overview Our client is seeking two (2) Claims Processors to review and adjudicate paper/electronic claims. Claims Processors will determine proper handling and adjudication of claims following organizational policies and procedures. Responsibilities Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. Use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems. Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with the Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Participate in ongoing developmental training to perform daily functions. Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc. Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions. Required Skills & Experience High School Diploma or GED and 2+ years claims experience. Administrative research experience. Previously processed 200-300 medical claims daily for prior roles. Demonstrated analytical skills. Demonstrated reading comprehension and ability to follow directions provided. Excellent written/oral communication skills. Demonstrated ability to navigate computer applications, namely, Microsoft Outlook and Excel. High attention to detail. Preferred Skills & Experience 1-3 years Claims processing, billing, or medical terminology experience. Exposure to health care, health insurance, medical information, and direct service experience.