Claims Processor II

Job Summary

Reviewing and adjudicating claims in a remote full-time capacity, the Claims Processor II will manage paper and electronic claims, ensuring compliance with organizational policies and timely payments while conducting extensive research and collaborating with customer service representatives.

Key responsibilities

• Examine and resolve non-adjudicated claims by identifying processing requirements based on contracts and policies
• Conduct extensive research using training materials and medical policy to ensure accurate claims processing
• Complete daily productivity data for performance statistics and assist customer service representatives with processing inquiries

Required qualifications

• High School Diploma or GED
• 3 years of claims experience required
• Preferred experience in claims processing, billing, or medical terminology
• Strong understanding of claims systems and processes
• Ability to meet established deadlines while managing multiple customer service demands