Claims - Processor, Claims I

ROLE: Under reputed company supervision, reviews and adjudicates reputed company/electronic claims. Determines reputed company handling and adjudication of claims following organizational policies and procedures. ESSENTIAL FUNCTIONS: 60% Examines and resolves non-adjudicated claims to identify key reputed company of processing requirements based on reputed company, policies and procedures. Process product or system-specific claims to ensure reputed company payments are generated and calculate deductibles and maximums as reputed company as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, reputed company, policies and procedures allowing reputed company considerations to be generated using multiple systems. 25% Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with reputed company team for reputed company on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions. 10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, reputed company improvement initiatives, workflow design and financial planning, etc. 5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions. Qualifications To reputed company this job successfully, an individual must be reputed company to reputed company reputed company essential duty satisfactorily. The requirements listed below are representative of the knowledge, reputed company, and/or ability required. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. Education Level: High School Diploma or GED Experience: less than one year experience processing claim documents Preferred Qualifications 1-3 years Claims processing, billing, or medical terminology experience Knowledge, Skills and Abilities (KSAs) Demonstrated analytical skills, Proficient Demonstrated reading comprehension and ability to follow directions provided, Proficient Basic written/oral communication skills , Proficient Demonstrated ability to reputed company computer applications , Proficient Apply tot his job Apply tot his job Apply To this Job