Claims Processor II - Florida Licensed

Job Summary

Ensuring the accurate and timely processing of claims, the full-time remote Claims Processor II - Florida Licensed will manage UB, HCFA, and Dental claims submitted by external providers while training providers, addressing appeals, and monitoring claim audits.

Key responsibilities

• Train providers and address appeals per CMS and NCCI guidelines while adjusting claims as necessary
• Monitor and clear pended claims through research and system updates, ensuring timely processing
• Conduct weekly batch reviews and audits to maximize the accuracy of claim payments and resolve billing issues

Required qualifications

• 3+ years of experience as a Claims Processor or in a similar position in a healthcare setting
• Ability to type 10,000+ KSPH and produce business correspondence for participants and regulatory agencies
• Intermediate customer service skills with experience communicating claims issues to various stakeholders
• Associates degree or Certificate in healthcare sciences, health information technology, or a related field
• Current experience in handling claims issues with physicians, participants, and regulatory agencies