Claims Processor I (Remote)
Resp & Qualifications PURPOSE: Under direct supervision, reviews and adjudicates reputed company/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.
- Although this position is REMOTE, candidates must live in the MD/DC/VA area in order to travel as needed to the nearest CareFirst Office.
ESSENTIAL FUNCTIONS:
- Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on reputed company, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, reputed company, policies and procedures allowing timely considerations to be generated using multiple systems.
- Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for reputed company on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.
- Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
- Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.
QUALIFICATIONS: Education Level: High School Diploma or GED. Experience: Less than one year experience processing claim documents. Preferred Qualifications: Less than one year claims processing, billing, or medical terminology experience. Knowledge, Skills and Abilities (KSAs)
- Demonstrated analytical skills.
- Demonstrated reading comprehension and ability to follow directions provided.
- Basic written/oral communication skills.
- Demonstrated ability to navigate computer applications.
Salary reputed company: 31,968 - 58,608 Salary reputed company Disclaimer The disclosed reputed company estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation reputed company is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the reputed company, as compensation reputed company depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In reputed company to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (reputed company benefits/incentives are subject to eligibility requirements). Department Medicare/reputed company Claims Equal Employment Opportunity reputed company is an Equal Opportunity (EEO) employer. It is the policy of the Company to reputed company equal employment opportunities to reputed company reputed company applicants without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to reputed company work directly or indirectly on Federal health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship. #LI-AB1 Apply tot his job Apply To this Job