Claims Processor

Job Description: Review and process medical claims submitted by members or providers promptly and accurately. Verify the accuracy and completeness of claim information, including patient demographics, diagnoses, procedures, and billing codes when available. Ensure compliance with insurance policies and industry standards. Investigate and resolve any discrepancies or issues related to claim submissions. Conduct comprehensive medical claims audits to identify errors, discrepancies, or fraudulent activities. Analyze claim documentation, including medical records and billing statements, to ensure adherence to coding guidelines and reimbursement policies. Research complex medical billing and coding issues to support claims processing and audit activities. Interpret coding guidelines, reimbursement policies, and legal requirements to determine appropriate claim adjudication. Provide recommendations for improving claims submission procedures and enhancing reimbursement accuracy. Serve as members' primary point of contact regarding claims inquiries and resolution. Respond promptly to customer inquiries and concerns with professionalism and empathy. Collaborate with cross-functional teams to address customer issues and ensure timely resolution. Requirements: High School Diploma or equivalent Proven experience in medical claims processing and healthcare reimbursement Strong knowledge of medical terminology, medical coding, and insurance billing practices Technical Knowledge: SalesForce Experience, Google Suite Experience, Claims Management Software experience Excellent analytical skills with the ability to interpret complex healthcare regulations and guidelines Exceptional attention to detail and accuracy in data entry and documentation Effective verbal and written communication skills with a customer-centric approach Must be a self-motivator and self-starter Exceptional listening and analytical skills Solid time management skills Ability to multitask and successfully operate in a fast paced, team environment Must adapt well to change and successfully set and adjust priorities as needed Benefits: Competitive salary and benefits package Dynamic and innovative work environment Opportunities for professional growth and development Remote work