Claims Processor
Diverse LynxTampa, FL, United States1 day ago
Job type
- Full-time
Job descriptionMinimum 5 years of experience in Claims Processing Minimum 3 years of hands-on experience with : Medicare & Medicaid claims Adjustments and Disputes (Appeals) Medical Coding UB04 & CMS1500 forms Problem-solving claims calculations (Benefit / Out-of-Pocket) Comfortable working from office Typing speed of 25 WPM with 90% accuracy 5-day working schedule Good typing speed required Candidates must be available onsite in the Tampa office for the first 8 weeks for training. After successful completion of training, the role transitions to remote (work from home) Ensure candidates meet the minimum 3 years of claims processing experience with the required skill areas mentioned above. Medical Claims Processing : Accurately review, verify, and process insurance claims following company policies and SOPs. Documentation Review : Analyze claim documents, medical records, and benefit summaries to determine eligibility and process claims accordingly. Customer and Internal Business Partner Interaction : Communicate with members, healthcare providers, and internal teams to resolve claims or gather additional information. Data Entry : Enter claim details and maintain accurate records in the claims management system. Continuous Improvement : Identify and implement process improvements to enhance accuracy and efficiency. Strong computer skills, including proficiency in MS Office Excellent verbal and written communication skills. Strong interpersonal skills and ability to work collaboratively in a team environment. Expert knowledge of the Healthcare domain with a focus on claims processing. Experience in Government Operations (Medicare and Medicaid). Strong understanding of insurance terminology : Copay, Coinsurance, Deductible, and Out-of-Pocket Ability to explain Medicare and Medicaid eligibility in detail. Experience as a Claims Examiner Level III for at least 3 years. Knowledge of Corrected Claims Processing CPT and HCPCS codes. Ability to understand California claims contract language Basic mathematical and analytical skills for claims benefit / out-of-pocket calculations Ability to coordinate benefits with Medicare and Medicaid 732-452-1006 , Ext : 285 Email
misam.raza@diverselynx.com | .com / in / connect2misam
Job Title : Claims Processor (Non-Voice / Back Office)
Work Location : Tampa FL (Remote)
Type : Fulltime
Qualification
- High School Graduate
Experience
Candidate Specification
Process Details
Please Note
Principal Responsibilities
Critical Skills Required
Thanks & Regards
Misam Raza
Sr. Talent Acquisition Specialist
Diverse Lynx 300 Alexander Park Suite| #200|Princeton, NJ 08540
Mobile- 732-582-8414
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