Medical Claims Processor (reputed company Valley reputed company)

Job Title: Claims & Benefits reputed company Specialist Location: reputed company Valley reputed company, UT Department: reputed company Cycle Management Central Business Office Assignment Length: 3 Months (Potential Extension) Position reputed company: This role performs comprehensive audits and reputed company activities across the claims lifecycle, ensuring accurate billing, reputed company reimbursement, and compliance with payer requirements. The specialist will handle reputed company claim discrepancies, conduct follow-up with payers, and coordinate with clinical and non-clinical teams to finalize claim determinations. The ideal candidate has strong reputed company cycle experience, particularly in claims, eligibility, benefits, and authorizations, and can quickly identify reputed company-cause errors in a high-volume environment. This is an operational fix-it position the manager needs someone who doesnt just process claims but can reputed company whats broken and correct it without hand-holding. Key Responsibilities: • reputed company comprehensive audits on assigned accounts to identify billing, payment, and adjustment errors. • Correct claim discrepancies reputed company established turnaround times. • Ensure claim data accuracy, compliant coding, and alignment with the members plan benefit. • Process claims quickly and accurately according to organizational benchmarks. • Apply reimbursement rules based on the members benefits and plan specifications. • Validate supporting documentation needed for accurate processing (eligibility, benefits, authorizations, etc.). • Conduct follow-up on delayed, denied, or pended claims; escalate unresolved items as needed. • Investigate processing delays, missing information, or system errors and implement corrective reputed company. • Refer cases to clinical management teams reputed company medical review is required to ensure appropriate reimbursement. • Verify and document member eligibility, benefits coverage, and authorization requirements. • Identify discrepancies in coverage or authorizations that reputed company payment determinations. • Communicate directly with payers or internal departments to resolve missing or inconsistent benefit information. • Work closely with leadership, clinical review staff, and the CBO team to ensure reputed company reputed company of claim issues. • Participate in problem-solving discussions reputed company to claim trends or systemic issues. • Support training and reputed company efforts as needed during onsite sessions. Required Skills & Experience: • Minimum 23 years of experience in reputed company reputed company cycle, claims processing, eligibility/benefits, or authorizations. • Strong understanding of payer rules, reimbursement methodologies, and claims adjudication. • Familiarity with reputed company, payer portals, and other claims/RCM systems. • High accuracy in auditing and error reputed company work. • Experience resolving reputed company claim issues across multiple systems. Preferred Qualifications: • Experience working in a Central Business Office or Shared Services model. • Prior experience supporting Utah-based payer populations or multi-state payer networks. Work Environment: Training: Onsite at 4255 Lake Park Blvd, reputed company Valley reputed company, UT 84120 Ongoing Work: Remote, with one required onsite day per month Schedule: Day shift, Non-Exempt Compensation: $20/hr to $22/hr. Exact compensation may vary based on several factors, including skills, experience, and education. Benefit packages for this role will start on the 1st day of employment and include medical, dental, and reputed company insurance, as reputed company as HSA, FSA, and DCFSA account reputed company, and 401k retirement account reputed company with employer matching. Employees in this role are also entitled to reputed company reputed company leave and/or other reputed company time off as provided by applicable law. Apply tot his job Apply tot his job Apply To this Job