Job Description
Job Role: Claims Processor
Location : Atlanta, GA (5 Days Onsite Mandatory)
Job Description:
Experience : 2-5 YEARS
Domain : Healthcare & Medical Devices
- Ability to work in office every day, no exceptions.
- Reliable transportation
- High School Diploma or equivalent required
- 1 year of previous insurance claims processing experience
Position Summary:
With direct supervision, the Claims Customer Service Rep will Analyze, review and adjudicate health insurance claims as well as Process health insurance claims for inpatient, outpatient facility and professional services.
Core Responsibilities:
- Understanding and interpreting health plan benefits and determining patient eligibility
- Maintaining patient confidentiality in accordance with Health Insurance Portability and Accountability Act (HIPAA) guideline
- Handle taking new claims and provide basic claim customer service
- Processes enrollment and eligibility changes from members and/or internal reports
- Professionally handle requests from client and ensure that issues are resolved both promptly and thoroughly
- Setting up claims and updating pertinent claims data into various claims systems
- Providing assistance with the completion of various claims related projects
Requirements:
- Understanding of health claims processing/adjudication
- Ability to perform basic to intermediate mathematical computation routines
- Medical terminology strongly preferred with understanding of ICD-9 & ICD-10
- Basic MS office computer skills
- Typing speed of 22 wpm & 85% accuracy
- Time management skills
- Written and verbal communication skills
- Attention to detail
- Must be able to demonstrate sound decision-making skills
Qualifications:
- High School/GED required
- 2 – 5 years’ experience in back-office processing or related field
- Must work well under pressure
- Have excellent interpersonal and communication skills
- Strong computer knowledge
- Familiar with Microsoft Office
- 10-key operation by touch
- Ability to complete extensive training program with satisfactory results
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