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Claims Processing Executive

Job Location:

Phoenix, AZ - USA

Hourly Salary: USD 19 - 20

Posted: 22 October 2026 (2 days ago)

Application Deadline: 19 January 2027

Vacancies: 1 Vacancy

Our client an IT Services and Consulting company is looking for a Claims Processing Executive for their Remote/IA location.

Responsibilities:

Claims Processing: Review validate and process healthcare claims submitted by providers in accordance with US insurance policies.
Core platform QNXT claims experienced - Preferred
Must have claims and facets experience
Eligibility Verification: Confirm patient coverage benefits and pre-authorization requirements under Medicare Medicaid and private insurance plans.
Adjudication: Approve deny or adjust claims based on payer guidelines and policy terms.
Compliance: Maintain adherence to HIPAA regulations CMS guidelines and other US healthcare compliance standards.
Documentation: Record claim activity maintain audit trails and prepare reports for management.

Requirements:

High school diploma or equivalent required
Strong knowledge of US healthcare insurance systems (Medicare Medicaid commercial payers).
24 years of experience in US healthcare claims processing
Familiarity with claims management software and EDI transactions.
Excellent analytical organizational and communication skills.
Ability to interpret insurance policies and payer guidelines.
Detail-oriented with strong problem-solving abilities.
Regulatory Knowledge Deep understanding of US healthcare laws and payer requirements.
Accuracy & Detail Orientation Ensures claims are processed correctly and efficiently.
Problem-Solving Resolves claim disputes and denials effectively.
Years of Experience: 2.00 Years of Experience