Claim Processor
Share
Job Location:
Monthly Salary:
Posted on:
19 hours ago
Vacancies:
1 Vacancy
Job Summary
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
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
