Medical Claims Processor I
Core
Accurate and timely entry, review, and resolution of simple to moderately complex medical claims in accordance with company policies and guidelines.
Role type
Medical Claims Processor I
Builds
Processed medical claims for insurance members
Domain
Healthcare insurance / Medical billing
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
10-key proficiency (135 spm), typing (35 wpm), medical terminology, CPT codes, ICD-9/10 codes, analytical reasoning, data entry
Preferred skills
Facets platform experience, knowledge of plan concepts (deductible, coinsurance, copay, out of pocket)
Technologies
Facets platform
Responsibilities
Enter claims data into system while interpreting coding and understanding medical terminology; Review, analyze, and resolve claims through the utilization of available resources; Analyze and apply plan concepts to claims; Examine claims to determine if further investigation is needed and route claims appropriately; Adjudication of claims to achieve quality and production standards; Release claims by deadline to meet company, state regulations, and contractual agreements; Review Policies and Procedures for process instructions and provide suggestions for potential process improvements
Seniority
Entry-level to Junior