Claim Processor

Job Description Claims Processor

Project Duration : 5 6 months

Work Hours : 7 : 00 AM 4 : 00 PM PST

Start Date : Targeting December 15th

Role Overview

The Claims Processor is responsible for validating members Out-of-Pocket Maximum (OOPM) cost shares based on the audit years listed in the Accumulator Overages Report. This role involves reviewing member responsibility according to plan benefits and ensuring that OOPM limits and any overages are accurate following predefined criteria. If a member exceeds the OOPM limit the excess amount is reimbursed through medical claims and pharmacy reimbursements.

Required Experience & Skills

1 3 years of experience in claims processing

Strong logical thinking ability

Knowledge of the US Healthcare industry

Proficiency in MS Office

Responsibilities

Adjudication and adjustment of claims with zero errors

Completion of claims in the queue within the specified time frame

Key Skills

Loan Processing,Typing,Data Entry,Customer Service,Organizational skills,Basic Math,Computer Skills,Fraud,Microsoft Outlook,10 Key Calculator,Fair Housing Regulations,Food Processing

Employment Type : Full Time

Experience : years

Vacancy : 1