Claims Processor

Job Summary

Responsible for the accurate and timely processing of claims, the remote Claims Processor II will adjudicate claims, resolve edits, and maintain reference materials while ensuring compliance with payment policies and contractual agreements.

Key responsibilities

• Adjudicates claims and adjustments, ensuring accuracy and compliance
• Resolves claims edits and suspended claims while providing backup support to team members
• Maintains and updates reference materials to facilitate effective claims adjudication

Required qualifications

• GED or High School diploma
• Experience with ICD-9/10 codes and Current Procedural Terminology (CPT)
• Demonstrated ability to navigate computer applications
• Basic analytical skills
• Experience in claims processing