Medicare Advantage Claims Processor
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Job Summary
Specializing in Medicare Advantage claims, the full-time Healthcare Claims Processor will manage complex medical claims processing remotely, focusing on the Inter-Plan Teleprocessing System (ITS) Home workflow and utilizing the Facets core software platform.
Key responsibilities
- Review, audit, and finalize complex medical claims routed via the electronic Inter-Plan Teleprocessing System (ITS)
- Validate and adjudicate out-of-state claims against localized Medicare Advantage benefit rules and plan guidelines
- Troubleshoot and resolve system pends and billing discrepancies to ensure seamless inter-plan provider reimbursement
Required qualifications
- HS Diploma or GED with 3+ years of healthcare claims processing experience
- Experience processing Medicare Advantage claims and utilizing the Facets core claims platform (Facets G6 or Facets 360)
- Prior experience with the ITS Home workflow and BlueCard program parameters is a plus
- Exceptional analytical skills for cross-referencing multi-layered plan benefits
- Strong productivity mindset for managing high-volume claims lines while maintaining data quality
Complete Job Description
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