Claims Processor
United StatesFull-TimeEntry
Salary not disclosed
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Job Details
- Experience
- Minimum of 6 months of experience in health and welfare claims processing.
- Required Skills
- Customer serviceMicrosoft OfficeData entry
Requirements
- High school diploma or GED required.
- Minimum of 6 months of experience in health and welfare claims processing.
- Basic understanding of claims adjudication principles, medical/dental terminology, and coding systems such as ICD-10 and CPT-4.
- Strong attention to detail with a high level of integrity and commitment to customer service.
- Excellent verbal and written communication skills.
- Ability to read, interpret, and apply business documents, benefit plans, and regulatory guidelines.
- Proficiency with Microsoft Office and general computer systems.
- Strong organizational skills with the ability to manage multiple tasks in a fast-paced environment.
Responsibilities
- Process routine health and welfare claims, including medical, dental, vision, prescription, life, AD&D, disability, and other benefit-related claims in accordance with plan guidelines and regulatory requirements.
- Apply knowledge of benefit plans and adjudication procedures to ensure accurate and timely claims payment decisions.
- Respond to customer inquiries via phone, written, electronic, or in-person communication, ensuring clear documentation and resolution.
- Maintain confidentiality and appropriate handling of protected health information (PHI) and personally identifiable information (PII).
- Interpret benefit plans, technical procedures, and regulatory materials to support accurate claims processing.
- Perform calculations related to benefits, including percentages, discounts, and other financial figures as required.
- Support additional administrative or operational tasks as assigned.
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