Claims ProcessorDiverse Lynx • Tampa, FL, United States
Claims Processor
Diverse Lynx • Tampa, FL, United States
20 hours 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 .
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
Office - 732-452-1006 , Ext : 285
Email - misam.raza@diverselynx.com | URL - https : / / www.diverselynx.com /
LinkedIn- linkedin.com / in / connect2misam
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