Elite Technical is seeking a Healthcare Claims Processor. The selected candidate will be the processing healthcare claims sent to our customer, a Health Plan in the Maryland area. This position will complete any necessary research and process claims according to established procedures. In the claims adjudication system, this includes claims for all Health Plan members with the exception of those claims involving additional coverage by non-Medicare carriers. In addition, this includes all claims with the exception of those claims where the Health Plan is the tertiary carrier and those claims requiring a higher skill level for adjudication including, but not limited to, foreign claims, high dollar claims, etc. The incumbent will be working with additional lines of business, for example, conversion plan, PPO's, etc. The position is also responsible for recognizing problems or inconsistencies that should be rejected to the member or provider (e.g. prior approval needed) or referred to other areas, such as Enrollment, Provider File, Review & Recovery, Utilization Management and Tech Support.

Required Skills

- 2+ years of Healthcare Claims Processing experience. Basic clarification of claims submission information by telephone may be necessary to complete the processing of a claim. Processing all claims, to include the release of applicable payments; with the exception of the claims requiring a higher skill level to adjudicate. This includes, but is not limited to, foreign claims, high dollar claims and claims in claims adjudication system involving additional coverage by non-Medicare carriers.
- Ability to recognize and process of simple adjustments (e.g. underpayments)
- Strong eye to detail: Identifying claims and documents to be referred to other areas.
- Medicare / Medicaid exp is a plus