The Claims Processor is responsible for processing claims by verifying and updating information on submitted claims, and reviewing processes required to determine reimbursement. Responsible for providing billing analyses of claims and applying standards of federal regulations to ensure correct billing practices.
Essential Duties & Responsibilities:
- Provide timely processing and adjudication of claims.
- Prepare documents and other paperwork related to claims.
- Respond to inquiries and resolve pertaining to specific claim issues.
- Manage medical and dental claims.
- Collaborate with other departments to obtain necessary information for resolution of claims.
- Performs other related duties as assigned.
Knowledge, Skills & Abilities:
- Knowledge of medical/dental coding for accuracy and reimbursement for claims processing.
- Professional phone etiquette and customer service.
- Strong attention to detail.
- Problem solving.
- Conflict resolution.
- Proficient in Microsoft Office Suite or related software.
- Minimum of one (1) year experience in processing medical claims based on the member’s benefits and provider’s contract. License not required.
- Strong data entry skills.
- Basic knowledge of medical procedures and terminology.
- Effective team player.
- Ability to foster relationships with co-employees and customers.
- Outstanding oral and written communication skills.
- Strong ethics and a high level of personal and professional integrity.
- Must have basic familiarity with federal and state laws and requirements relating claims administration.
- Proficient level computer skills; Word, Excel, PowerPoint etc. (All MS office products).
- Prolonged periods sitting at a desk and working on a computer.
Disclaimer: The above statements are intended to describe the general nature and level of work performed by employees assigned to this classification and has been created to advertise the open position(s). These statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. MBA Inc. is an Equal Opportunity Employer (E.O.E).
*This position requires all potential candidates to complete background check and drug screen prior to any offer of employment.