Claims Processor

Remote opportunity for a Claims Processor to support our customer, a major Healthcare Insurance organization. Under direct supervision, the selected candidate will review and adjudicate paper/electronic healthcare/medical claims and will determine proper handling and adjudication of claims following organizational policies and procedures.

-60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
-25% Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately.
-10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
-5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

This position is a contract to permanent opportunity with our customer. Although this position is 100% remote, we are seeking candidates that reside in one of the following approved states: DC, MD, VA, WV, NC, PA, DE, NY, NJ, TX, FL

Required Skills

-Education Level: High School Diploma or GED
-Experience: 2+ years Healthcare Claims processing and data entry experience. Prior experience processing 300+ claims per day is preferred level of experience
-Must have basic medical terminology experience
-Must have basic knowledge around MS Excel

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Anticipated Start Date

Monday, April 29, 2024

Anticipated Duration

12 month T2P

Date Posted

Monday, April 1, 2024

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Elite Technical Services, Inc. participates in the E-Verify program to confirm the employment eligibility of all persons hired. This means that we will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee's Form I-9 to confirm work authorization. Elite Technical Services, Inc. will not use E-Verify to pre-screen job applicants.

Elite Technical Services, Inc. is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.