Claims Processing Executive

Role: Claims Processing Executive Location: Remote Contract: 6+ Months Job Summary Join our team as a Claims Processing Executive in the healthcare sector, leveraging your MS Excel and QNXT claims processing expertise to manage and process commercial claims. This remote, day-shift role offers work-from-home flexibility while contributing to accurate claims adjudication, operational efficiency, and customer satisfaction.

Responsibilities

Claims Processing: Review, validate, and process healthcare claims per US insurance policies. QNXT Platform: Hands-on experience with QNXT claims processing is required. Eligibility Verification: Confirm coverage, benefits, and pre-authorization requirements for Medicare, Medicaid, and commercial plans. Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms. Compliance: Ensure adherence to HIPAA, CMS, and other US healthcare regulations. Documentation: Maintain claim records, audit trails, and management reports. Required Skills & Qualifications High school diploma or equivalent (required). Strong knowledge of US healthcare insurance systems, including Medicare, Medicaid, and commercial payers. 2 to 4 years of US healthcare claims processing experience. Experience with claims management systems and EDI transactions. Strong analytical, organizational, communication, and problem-solving skills. Ability to interpret insurance policies and payer guidelines. Competencies Regulatory Knowledge: Strong understanding of US healthcare regulations and payer requirements. Accuracy & Attention to Detail: Ensures efficient and error-free claims processing. Problem-Solving: Effectively resolves claim denials, discrepancies, and disputes.