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Medical Claims Processor – Remote – United States
Job Description:
• Pay or deny claims according to the benefit summary
• Review membership eligibility for determination
• Assign correct provider for proper payment
• Follow all HIPAA guidelines
• Review member’s out of pocket for correct cost share application
• Review COB information and apply it accordingly
• Review Error codes, warning messages and edits for correct processing
• Analyze claims for correct payment verification and adjust where needed
• Use of the Facets system to adjudicate claims
Qualification:
• High school diploma or GED
• Experience with claims or customer service in medical field
• Ability to work independently and with others in a fast-paced production based environment
• Basic Excel skills
• Priority will be given to those with knowledge of the Facets systems and application
• Knowledge of Medicaid, Medicare or commercial claims processing
• COB and benefit summary knowledge
