[Hiring] Claims Processing Executive @Pyramid Consulting

Role Description

Immediate need for a talented Claims Processing Executive. This is a 06+ months contract opportunity with long-term potential and is located in IOWA (Remote).

Key Responsibilities:

• Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
• Core platform – QNXT claims experienced - Preferred
• MUST HAVE CLAIMS and FACETS experience
• Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
• Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
• Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
• Documentation: Record claim activity, maintain audit trails, and prepare reports for management.

Qualifications

• High school diploma or equivalent REQUIRED
• Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers).
• 2–4 years of experience in US healthcare claims processing
• Familiarity with claims management software and EDI transactions.
• Excellent analytical, organizational, and communication skills.
• Ability to interpret insurance policies and payer guidelines.
• Detail-oriented with strong problem-solving abilities.

Requirements

• Regulatory Knowledge – Deep understanding of US healthcare laws and payer requirements.
• Accuracy & Detail Orientation – Ensures claims are processed correctly and efficiently.
• Problem-Solving – Resolves claim disputes and denials effectively.

Benefits

• Employee benefits include, but are not limited to, health insurance (medical, dental, vision).
• 401(k) plan.
• Paid sick leave (depending on work location).