Claims Processor

Claims Processor – Job Summary

The Claims Processor is responsible for accurately reviewing, coordinating, and processing provider network and hospital claims in compliance with regulatory guidelines and internal procedures. This role validates claim documentation, and requires comprehensive knowledge of clinical billing codes, medical terminology, and healthcare reimbursement practices.

Key Qualifications:

• Associate degree preferred.
• Minimum 3 years of healthcare claims processing experience, including COB.
• Proficiency with Electronic Medical Records (EMR) systems, and Microsoft Office (Word, Excel, Outlook).
• Strong analytical, organizational, and interpersonal skills.
• High attention to detail
• Ability to work independently under deadline-driven environments.

Key Responsibilities:

• Process and adjudicate provider and hospital claims in accordance with established procedures and contract terms.
• Maintain up-to-date knowledge of CPT/HCPCS/ICD codes
• Review and validate authorizations, EOBs, coding, and payment justifications.
• Conduct provider outreach to resolve discrepancies and ensure accurate claim submission.
• Provide customer service to providers and internal staff regarding claim inquiries.
• Participate in training sessions, audits, and procedural updates as needed.
• Uphold confidentiality and compliance with financial and medical data.

Pay: From $20.00 per hour

Work Location: In person