Claims Processor II

About Our Client: The organization operates within the healthcare industry, focusing on improving the functionality, accessibility, and outcomes of healthcare services. It addresses challenges in healthcare delivery by providing solutions that enhance customer experiences, streamline healthcare processes, and support members and providers. The organization also engages communities through educational resources and programs designed to promote better health outcomes and service quality. About the Opportunity: The Claims Processor II handles moderately complex claims to ensure accurate, timely, and consistent processing in accordance with applicable contracts, policies, and procedures. This role researches claim information, resolves processing issues, and maintains high standards for accuracy and productivity. The position contributes to reliable claims outcomes for members and providers while supporting overall operational excellence. Responsibilities: • Review and resolve moderately complex claims in accordance with applicable contracts, policies, and procedures.• Research claims using reference materials, online resources, and other available tools.• Accurately code and process claims within the designated claims processing system.• Enter and maintain claim information and follow up on pending claims.• Maintain accurate claims files and prepare claims for return when additional information is required.• Meet established adjudication accuracy, productivity, and quality standards.• Maintain confidentiality of claims documents, records, and other sensitive information.• Communicate with other insurance carriers, providers, and relevant parties as needed to obtain or clarify information.• Provide training, guidance, and feedback to new associates when required.• Process claim adjustments, reversals, refunds, and other corrections as applicable.• Apply quality standards and established procedures to minimize errors, rework, and processing delays. Requirements: • High school diploma or GED.• Minimum 6 months of experience in claims processing, customer service, healthcare administration, or a related field.• Experience with out-of-area claims programs preferred.• Technical knowledge of contract benefits, claims processing procedures, and claim correction processes.• Strong attention to detail and ability to accurately interpret and apply claim information.• Strong organizational and time-management skills.• Ability to work effectively in a structured, production-focused environment.• Strong communication and problem-solving skills. Pay Range and Compensation Package: • The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, qualifications, location, and other relevant factors. Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.