Claims Processor

A company is looking for a Claims Process Executive (remote).

Key Responsibilities

Review and process claims submissions for appropriateness and completeness according to guidelines

Approve, deny, or pend claims based on coverage guidelines and maintain compliance with regulations

Interact with internal staff and external parties to resolve claims issues and ensure accurate information

Required Qualifications

High School diploma or GED required

Minimum of two to three years of Medicaid and / or Commercial claims payer processing experience

Knowledge of medical terminology and coding (CPT-4, ICD-9, ICD-10, HCPCS, ASA, UB92)

Experience in navigating multiple systems and proficient in Microsoft Office applications

Ability to work remotely in a secure environment with a high-speed internet connection