Claims Processor II

JOB DESCRIPTION ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. Must have: Medical/healthcare claims processing experience Experience with list of ICD 9/10 codes and CPT Responsible and accountable for the accurate and timely processing of all claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements. Adjudicates claims and adjustments as required. Resolves claims edits and suspended claims. Maintains and updates required reference materials to adjudicate claims. Provides backup support to other team/group members in the performance of job duties as assigned. Manually prices claims with various tools and processes to pay the claims. Utilizes reference materials and analyzes updated materials to adjudicate claims. This includes reviewing material updates daily and sharing feedback or suggestions if any concerns arise. Partners with the Quality team for clarity on procedures and complex claims and receives coaching from leadership. The job duties listed above are representative and not intended to be all-inclusive of what may be expected of an employee assigned to this job. A leader may assign additional or other duties which would align with the intent of this job, without revision to the job description. #LI-Remote ADDITIONAL QUALIFICATIONS/RESPONSIBILITIES Demonstrated ability to navigate computer applications. Experience with list of ICD-9/10 codes and Current Procedural Terminology (CPT). Demonstrated basic analytical skills. Basic written/oral communication skills. Demonstrated reading comprehension and ability to follow provided directions. General Job Information Title Claims Processor II Grade 19 Work Experience - Required Claims Work Experience - Preferred Education - Required GED, High School Education - Preferred License and Certifications - Required License and Certifications - Preferred Salary Range Salary Minimum: $37,725 Salary Maximum: $56,595