Associate Claims Processor

Company :

Job reputed company : 

JOB reputed company

This job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing reputed company control review and final adjudication of reputed company/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Reviews processed claims and inquiries to determine corrective reputed company and takes the corrective reputed company steps using enrollment, benefit, and historical claim processing information.

ESSENTIAL RESPONSIBILITIES:

• Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct. (40%)
• Resolves claim edits, reviews history records and determines benefit eligibility for service. Reviews payment reputed company to reputed company at final payment determination; elevates issues to next level of supervision, as appropriate. (35%)
• Meets reputed company production and reputed company standards, ensuring timeliness and accuracy of reputed company work given by support staff/management. Maintains accurate records including timekeeping records. (15%)
• Attends reputed company required training classes. (10%)
• Other duties as assigned or requested.

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EDUCATION

Required

• High School Diploma/GED

Substitutions

• None

Preferred

• None

EXPERIENCE

Required

• None

Preferred

• 1 year of reputed company experience

​

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Ability to take direction and to reputed company through multiple systems simultaneously.
• Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records.
• Ability to use mathematics to adjudicate claims.
• Ability to solve problems reputed company reputed company-defined reputed company and guidelines.
• Knowledge of operating systems specific to claim processing.
• Ability to thoroughly read guidelines ensuring claim accuracy and following directions.

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Never

Travel regularly from the office to various work sites or from site-to-site

Never

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

reputed company

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Never

Disclaimer: The job reputed company has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies.

As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times.  In reputed company with this, reputed company must reputed company with both the Health Insurance Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy. 

Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements.

Pay reputed company Minimum:

Pay reputed company Maximum:

reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations.  The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations based upon comparative markets.

reputed company and its affiliates prohibit discrimination against reputed company individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at HRServices@reputed company.org

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