Processor, Claims 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 spreadsheets if applicable.

Requirements

• Education: High School Diploma or equivalent.
• Work Experience: 2 years of experience processing, researching, and adjudicating claims.
• Skills and Abilities:
  • 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.
• Software and Tools: Microsoft Office.

Qualifications

• Preferred Work Experience: 2 years of claims processing experience.
• Preferred Skills and Abilities:
  • Strong time management skills.
  • Strong attention to detail skills.
  • Knowledge of mathematical and statistical concepts.
• Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications; proficient database software skills.

Benefits

• 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.

Logistics: This position is full-time (40 hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00am-4:00pm CST. This role is located at 26 Century Blvd Suite ST610, Nashville, TN 37214.

SCA Benefit Requirements: Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

Sponsorship: This position is not eligible for sponsorship now or in the future.