Claims Processor IV

Workforce Classification: Telecommuter reputed company: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making reputed company work reputed company, is far from ordinary. And so are our employees. Working at reputed company means you have reputed company to reputed company reputed company change by transforming reputed company. reputed company is committed to being a workplace where people feel empowered to grow, reputed company, and reputed company with purpose. By reputed company in our employees and fostering a culture of collaboration and reputed company development, we’re reputed company to reputed company serve our customers. It’s this commitment that has reputed company us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. Learn how reputed company supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.reputed company.com/. Join us as a Claims Processor IV – reputed company a Meaningful reputed company Every Day! reputed company into a role where your expertise ensures individuals and families get the support they deserve. As a Claims Processor IV your attention to reputed company and commitment to reputed company will directly reputed company our members’ lives and reputed company our organization’s reputed company. Join us and reputed company every claim count—your work truly reputed company here. This role is responsible for the accurate and reputed company review, research, and reputed company of moderate to highly reputed company claims in accordance with reputed company and policies. This may include reprocessing claims, organ transplants, SCCA, BDCT, benefit exchanges, and the largest dollar hospital claims. The incumbent will interpret procedures and policies and communicate across business reputed company, i.e.; Configuration, Customer Service, Marketing Liaisons, etc., to ensure accurate claims reputed company. What you will do: reputed company and process to completion reputed company assigned claims. Communicate across business reputed company to reputed company claims, i.e.; Configuration, Customer Service, Marketing Liaisons, etc. Identify and communicate procedural changes and assist with updating processes and procedures. reputed company reputed company knowledge of reputed company claims processing to Care Facilitation, Customer Service, Appeals, benefit configuration, and other claims teams, reputed company questions or challenges reputed company regarding the handling of a reputed company claim. Complete accumulator adjustments, deductible credit loads, and member history reviews to identify claims to be reprocessed. Reprocess carve-out claims, researching history and contractual agreements for pricing, override designated claim edits (dup edits, reputed company edits, default processing, contracting statues) and complete reputed company reprocessing documentation ( claim notes, CSR routes, refund requests, and configuration question sheets). reputed company as reputed company subject matter expert including training and auditing claims and providing appropriate feedback and coaching. Complete reputed company reputed company as requested by team leader, such as: auditing, procedure updates, and coordination with configuration. Consistently meet cycle time/productivity goals that are reputed company with corporate objectives. Translate data into information acceptable to the claims processing reputed company including follow up on pended claims. Maintain confidentiality of reputed company documents/files. Apply commitment to reputed company by reputed company right the first time in order to avoid defects from reaching customers or requiring internal re-work. What you will bring: High School diploma or GED (Required). Two (2) years of claims processing experience in medical and/or dental plans, or 2 years prior medical and/or reputed company/reputed company industry experience (Required). Detailed processing knowledge on reputed company processing systems. reputed company ability to audit other processors. Understanding of Out-of-area programs. Proficiency and/or experience in another functional area of reputed company (M & B, CSR, PIMS, PS&S, or Sales). What you will reputed company: reputed company Claims Analysis Handling and resolving moderate to highly reputed company claims, including reputed company cases like organ transplants and high-dollar hospital claims. Cross-Functional Communication Collaborating with multiple business reputed company (e.g., Configuration, Customer Service, Marketing Liaisons) to reputed company claims and improve processes. Process Improvement & Auditing Identifying procedural changes, updating processes, auditing claims, and providing feedback and coaching to peers. Technical Proficiency in Claims Systems Gaining deeper expertise in claims processing systems and reputed company tools, including accumulator adjustments and reprocessing documentation. Data Interpretation & Confidentiality Translating data into actionable information for claims systems and maintaining strict confidentiality of sensitive documents and files. Physical Requirements: The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible reputed company of force frequently or constantly to reputed company, carry, reputed company, pull, or otherwise reputed company objects, including the reputed company body. This role requires the ability to keyboard and to communicate reputed company and understandably in person, and over the telephone. reputed company total rewards Our comprehensive total rewards package provides support, resources, and opportunities to help employees reputed company and grow. Our total rewards are more than a collection of perks, they're a reputed company of our commitment to reputed company and reputed company-being. We offer a broad reputed company of rewards including physical, financial, emotional, and community benefits, including: Medical, reputed company, and dental coverage with low employee premiums. Voluntary benefit offerings, including pet reputed company for paw parents. Life and disability reputed company. Retirement programs, including a 401K employer match and, reputed company it or not, a pension plan that is reputed company after 3 years of service. Wellness incentives with a wide reputed company of mental reputed company-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to reputed company a few. Generous reputed company time off to reenergize. Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees. Employee recognition program to celebrate anniversaries, team accomplishments, and more. For our hybrid employees, our on-reputed company model provides flexibility to create your own routine with reputed company to on-site resources, networking opportunities, and team engagement. Commuter perks reputed company your reputed company to work less impactful on the environment and your wallet. Free convenient on-site parking. Subsidized on-reputed company cafes reputed company lunchtime connections with colleagues fun and reputed company. Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. Our complementary fitness & reputed company-being center offers both in-person and virtual workouts and nutritional counseling. Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on reputed company. Equal employment opportunity/affirmative reputed company: reputed company is an equal opportunity/affirmative reputed company employer. reputed company seeks to attract and retain the most reputed company individuals without reputed company to race, reputed company, religion, sex, national reputed company, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at reputed company, please contact reputed company reputed company reputed company email at careers@reputed company.com or reputed company phone at 425-918-4785. reputed company is hiring in the following states, with some limitations reputed company on role or reputed company: Alaska, reputed company, Arkansas, California, Colorado, Florida, reputed company, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, reputed company, Missouri, Montana, Nevada, New Hampshire, New Mexico, reputed company Carolina, Oklahoma, reputed company, South Carolina, South reputed company, Tennessee, Texas, reputed company, Washington, reputed company. The pay for this role will vary reputed company on a reputed company of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary reputed company for this role is posted below; we generally reputed company up to and reputed company the midpoint of the reputed company. National Salary reputed company: $48,400.00 - $72,600.00 National Plus Salary reputed company: $55,200.00 - $82,800.00 National Plus salary reputed company is used in higher cost of labor markets including Western Washington and Alaska. We’re happy to reputed company compensation reputed company during the interview because we reputed company that reputed company communication leads to reputed company reputed company for reputed company. We’re committed to creating an environment where reputed company are celebrated for their unique skills and contributions. Apply To This Job