Claims Processor

Job Summary

Responsible for the accurate and timely processing of claims, the remote Claims Processor II will adjudicate claims, resolve edits and suspended claims, and maintain reference materials while providing backup support to team members.

Key responsibilities

• Adjudicates claims and adjustments according to payment policies and contractual agreements
• Resolves claims edits and suspended claims, ensuring timely processing
• Maintains and updates reference materials for accurate claims adjudication

Required qualifications

• High School diploma or GED
• Experience navigating computer applications
• Familiarity with ICD-9/10 codes and Current Procedural Terminology (CPT)
• Demonstrated basic analytical skills
• Ability to follow provided directions and comprehend written materials