Healthcare Claims Processor

Published
January 2, 2021
Location
Plano, TX
Category
Job Type

Description

ESSENTIAL QUALIFICATION:

  • Overview of US Healthcare Industry
  • A-Level professional with 1-2 years of experience in Actual Healthcare claims processing
  • Processing and adjudication medical claims.
  • Maintaining integrity of claims receipts in accordance with standard claims operating and adjudication procedures.
  • Accurately resolving pending claims using state and federal regulations and specific health plan criteria.
  • Working within turnaround times to meet client performance guarantees for claims processing.
  • Good logical thinking & analytical ability
  • Should have exposure to MS Office (high proficiency with MS Excel)
  • Good keyboard skills, minimum typing speed of 30 wpm or above
  • Good verbal & written communication skills, ability to interact via email/online applications

ESSENTIAL SKILLS/PERSONALITY TRAITS:

  • Eye for detail
  • Logical thinking & analytical skills
  • Ability to work with limited supervision
  • Ability to work accurately and efficiently at all times, including redundant claim types
  • Ability to multi-task and manage time efficiently under the pressure of deadlines
  • Sensitivity to the confidential nature of the data and proprietary company information

OPERATIONAL RESPONSIBILITY:

  • Ensure to meet all Statistical, Financial and TAT metrics while processing claims
  • 100% adherence to transaction processing timelines
  • Adhere to audit compliance (Internal, Statutory Audit) of all Healthcare processes as laid out by Company / the client of Company
  • Ensure process guidelines are followed and met as documented

PERFORMANCE STANDARDS:

MEASURABLE

  • Number of claims adjudicated/adjusted in a day
  • Accurate and thorough review of all assigned claims
  • Turnaround Time
  • Attendance and Punctuality

NON-MEASURABLE:

  • Self-motivation
  • Team Player
  • Reliability
  • Professionalism
  • Personal grooming and etiquette
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