Medical Claims Processor

Job Title - Remote Medical Claims Processor

Job Type - Employee, Full Time (40 hours a week) or Employee

Duties and Responsibilities:

• Responsible for accurate and timely adjudication of claims following GBS protocol.
• Analyze, process, research, adjust and adjudicate claims with timely reviewing for covered procedures/revenue and ICD-10 codes. Ensure accurate application of benefits with EOB/payment issuing to the correct provider.
• Process claims based upon contractual and/or Our Client agreements, use of established payment methodologies, applicable regulatory legislation, GBS policies and claims procedures guidelines.
• Identify claim overpayments and request refunds.
• Compile detailed reports as requested.
• Alerts manager or supervisor of issues that impact production and quality, i.e. incorrect database configurations, non-compliant claims, inefficient processes, system interface issues, etc.
• Answer incoming calls promptly and professionally, addressing inquiries and concerns from healthcare professionals and plan members. Document calls and complete follow up steps, if needed, to resolve caller requests. (outbound calls, research, fax, etc.)

Top Qualities of the Ideal Candidate:

• Manage time / prioritize effectively, having the ability to handle complex issues and constant change.

• Quality-focused performance

• Must be well organized, able to multi-task while remaining detail oriented

• Must be proficient working with database and processing software, excel, word and outlook

• Must have good mathematical, problem solving and analytical skills

• Provide the best customer service to all customers (external and internal) using professional written and verbal skills

Education and Experience Level

The ideal candidate will possess at least a High School Degree and some college and/or technical training with at least three (3) years of actual Claims Processing experience in the Health Insurance Industry. At least 2 years experience in a call center environment with skills in call resolution and customer support. Leadership and Customer Service experience in the Health Industry is very helpful. Medical Terminology is preferred.

Benefits

Medical, Dental, Vision, Group Life, Dependent Life, Short Term Disability, Long Term Disability, Voluntary Life, PTO, Paid Holidays, Simple IRA and Bonus Program