Medical Claims Processor (On-site)

Job Summary:

The Claims Processor is responsible for researching, resolving, and processing claims timely and accurately within the standard metrics.

Supervisory Responsibilities:

This position has no direct supervisory responsibilities.

Duties/Responsibilities:

• Process transactions assigned as per the defined standard operating procedure.
• Meet or exceed the production & quality accuracy target/goals assigned.
• Plans, prioritizes, organizes, and completes work to meet established objective.
• Ensure the compliance of the company’s policies to cooperate with standards and procedures.
• Answer questions and resolve issues for consumers and clients timely and accurately.
• Perform other related duties as assigned.

Required Skills/Abilities:

• Typing skills and accuracy in keying data required.
• Should have strong analysis skills, including the ability to catch data that represents inaccurate/incomplete from the actuals.
• Should be good in logical reasoning and connect to the process to catch errors.
• Extensive knowledge of medical terminology with the ability to correctly read and assess medical documents.
• Basic cognitive skills that include language, math, and reasoning ability.
• Solid interpersonal skills with the ability to work with people with diverse backgrounds (both non-technical and highly technical users). Demonstrated ability to build and maintain business relationships internally and externally.
• Decision-Making Skills - Capable of arriving at the appropriate decisions after weighing the pros and cons of all the options.
• Excellent verbal and written communication skills in addition to be a good listener to give value to the opinion and suggestion of others. This includes ability to communicate with the customers if needed.
• Exceptional problem solving and solution driven skills with the ability to review problem, troubleshoot root cause issues and determine path to resolution.
• Strong attention to detail to handle the complex claims.
• Able to work effectively in a changing environment and be able to contribute innovative ideas.
• Excellent time management and organizational skills balancing multiple priorities.
• Self-starter, able to independently drive work.

Education and Experience:

• 1 year of experience in processing healthcare claims
• High school diploma or equivalent

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.