Claims Processor

Title: Claims Processor

Duration: 12 Months CTH

Location: Fairfax, VA (100% Remote Job)

W2 Rate: $23/hr.

Job Purpose:

Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.

Required Experience:

1-3 years experience processing claims documents

Experience with MS Excel is a must

Previously adjudicated 200-300 medical claims daily with accuracy of 98% or above for prior roles.

1-3 years Claims processing, billing, or medical terminology experience

Essential Functions:

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.

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