Claims Technician, Springfield IL
Core
Process complex healthcare claims requiring investigation, adjudication, and coordination of benefits to ensure timely resolution for members and providers.
Role type
Claims Technician (Healthcare)
Builds
Accurate claim adjudications and resolved member/provider issues
Domain
Healthcare insurance and claims processing
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical claims processing, data entry, PC/Windows/Microsoft Office, HIPAA compliance, medical terminology, coordination of benefits
Preferred skills
Blue Chip claims system training, CPT/HCPCS/ICD9 coding knowledge, BlueCard Medical Records experience, claims adjudication systems familiarity
Responsibilities
Investigate claim discrepancies and resolve denials, contact providers to verify information, coordinate benefits and update patient files, process complex pended and duplicate claims, research other insurance/Medicare/Medicaid coverage, apply financial suspense system data to claims
Seniority
Entry-level, supervised IC
