Claims processor iii - united states, baltimore
do you have experience with health insurance claims? our client, carefirst, is now hiring immediately for a claims processor to support their baltimore, md location. this role is remote, but candidates must reside in md/dc/va area.
responsibilities:
* provides timely and accurate processing and adjudication of claims at an expert level. processes catastrophic and highly complex claims. researches and processes highly complex and non-standard claims adjustments and file corrections for member accounts, which may involve various company products, such as indemnity, ppo, hmo, pos, individual market, fep, dental, etc.
provides leadership to less experienced staff and may assist in training classes
* uses expert knowledge of claims processing to examine all types of claims and identify key elements and processing requirements based on diagnosis, provider, paykey, medical policy, contracts, and policies and procedures. efficiently and accurately processes all types of claims, including catastrophic and highly complex claims, utilizing broad based product or system knowledge to ensure timely payments are generated. calculates deductibles and maximums, as well as researches and resolves system pends. works with other departments, such as medical review, to complete claims processing.
* handles catastrophic and highly complex claims, as well as non-standard processing. audits work of other claims processors for quality assurance. makes claims adjustments for all dollar volumes. utilizes broad based product or system knowledge
requirements:
* required: high school degree plus 3+ years of claims experience for internal hires, or equivalent internal/external experience for external hires
* abilities/skills: demonstrated mathematical, data entry/pc, stress management, and organizational skills. reasoning ability, teamwork, and customer service also required. strong written/oral communication skills. advanced problem solving skills experience with ms excel, ms word, and ms outlook
* preferred: billing or medical terminology experience
*proof of covid vaccination is required*
what's in it for you:
apply now! interviews are being conducted asap!
equal opportunity employer/veterans/disabled
the company will consider qualified applicants with arrest and conviction records
Apply to this job now Report abuse