STRATEGIC STAFFING SOLUTIONS HAS AN OPENING! This is a Contract Opportunity with our company that MUST be worked on a W2 Only. No C2C eligibility for this position. Visa Sponsorship is Available! The details are below. Beware of scams. S3 never asks for money during its onboarding process. Title: Claims ProcessorDuration: 3+ MonthsRemote Work (Must be local to Louisiana) Ref# 238482Job Profile Summary:
- Researches and verifies complex claims information to ensure the accurate and timely processing of claims.
- Enters all information needed to process claim.
- Identifies inconsistencies and makes necessary corrections.
- Accountable for complying with all laws and regulations associated with duties and responsibilities.
Job Description:
- Researches and verifies complex claims information to ensure the accurate and timely processing of claims.
- Enters all information needed to process claim.
- Identifies inconsistencies and makes necessary corrections.
- Accountable for complying with all laws and regulations associated with duties and responsibilities.
- This role reports to this job: SUPERVISOR, CLAIMS OPERATIONS
- In order to effectively fulfill this position, the Claims Processor must be in contact with: Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Operations Management and staff, Membership and Billing, Administrative Services, and District Offices.
- Various external entities including, but not limited to, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, and other Plans.
Required Qualifications: Education:
- High School Diploma or equivalent required
- Associate's is preferred
Work Experience
- 1 year of related clerical or data entry is required
- A medical office or medical coding diploma can be used in lieu of the one year of experience
- Claims processing or claims coding experience is preferred
- Must be able to enter data at 4000 keystrokes per hour
- Medical coding training is preferred
- Must be able to demonstrate critical thinking and problem-solving skills
- Familiarity with medical and health insurance terminology preferred
- Demonstrated verbal and written communication skills with the ability to interpret and communicate information with tact, diplomacy, patience and professionalism.
- Must demonstrate PC skills including Microsoft Office (e.g., Word, Excel, Outlook, etc.)
Accountabilities And Essential Functions
- Reviews and corrects scanned claims documents upon receipt as well as enters coded information, checks claim for completeness and accuracy of information prior to final entry, while identifying and resolving inconsistences, and appropriately returns claims requesting missing information in accordance with established quantity, quality, and timeliness guidelines ensuring contract benefits are applied correctly, ultimately providing a high degree of customer satisfaction.
- Consistently researches procedural questions using supporting documentation while identifying incomplete adjudication instructions found within the supporting documentation, allowing for participatory suggestions for updating and correcting procedures, identifies training issues, and appropriately checking with management, when necessary, to provide excellent quality in claims adjudication.
- Maintains and records information necessary for accurate recording and calculation of production, which include number of edits processed, hours worked, downtime and special projects assignments daily.
- This information is retained as historical data which is needed to continually refine and define the claims processor position as needed to ensure high customer satisfaction.
- Rejects, redirects misrouted or sends back claims when information is incomplete or inaccurate to facilitate timely processing ensuring that claims are processed according to departmental guidelines and assist with customer service.
- Research procedural questions in training manual.
Job ID: JOB-238482 Publish Date: 14 Oct 2024