Claims Processor II

About the role

Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.

Responsibilities

• Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Verifies that claims have been keyed correctly.
• Ensures that claims are processing according to established quality and production standards.
• Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
• Researches and resolves claims edits and deferrals.
• Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
• Responds to routine correspondence and completes spreadsheet if applicable.

Qualifications

Required Education: High School Diploma or equivalent

Required Work Experience: 2 years of experience processing, researching and adjudicating claims.

Required Skills

• Strong organizational, analytical and judgment skills.
• Strong oral and written communication skills.
• Proficient in spelling, punctuation and grammar.
• Proficient in basic business math.
• Ability to handle confidential or sensitive information with discretion.
• Microsoft Office.

Preferred Qualifications

Preferred Work Experience: 2 years of claims processing experience. Tricare claims experience.

Preferred Skills: Strong time management skills. Knowledge of mathematical and statistical concepts.

Preferred Software: Proficient in word processing and spreadsheet applications. Proficient database software skills.

Schedule

This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. The role is located on-site at 17 Technology Circle, Columbia, SC 29203. This position is not eligible for sponsorship now or in the future.

Benefits

Eligible to participate in benefits for the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more