[Hiring] Claims Processor @GuideWell Source

Role Description

This position is responsible for entering paper and/or electronic claims into the claims system and examining and determining whether to return, request additional information, deny or pay claims following organizational policies and procedures after entry. After the appropriate training, incumbents are expected to meet the minimum levels for quality and production as measured by the Claims Department.

Essential Responsibilities

• Accurately examine, interpret and enter claims; resolve edits and first/second level suspense utilizing the claims processing system.
• Perform necessary research and effectively make decisions to properly adjudicate claims utilizing processing manual.
• Identify and communicate problems relevant to the claims processing system and the processing manual and/or guidelines.
• Adhere to all established standard operating procedures.
• Support continuous improvement by identifying process improvements and/or quality enhancements.
• Initiate and respond to written and verbal communications from internal and external sources.
• Perform Claim Adjustments of initial claims for internal and external adjustment reasons, resolving claims suspensions resulting from claim adjustments.
• Resolve Medicare Secondary Payor (MSP) edits/audits/reason codes.
• Perform other duties as the supervisor may, from time to time, deem necessary.

Qualifications

• High School Diploma or GED
• 1 year of data entry experience, including accurate keyboard skills
• Proficient with PCs and in Windows based environments; including Microsoft Office (Word, Excel, Outlook)
• Demonstrated analytical skills
• Strong verbal and written communication skills
• Strong interpersonal skills

Preferred Qualifications

• Knowledgeable of medical terminology, procedure and denial codes

Requirements

• The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive.
• Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment.
• Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards.

Benefits

• Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
• Short- and long-term disability benefits
• 401(k) plan with company match and immediate vesting
• Free telehealth benefits
• Free gym memberships
• Employee Incentive Plan
• Employee Assistance Program
• Rewards and Recognition Programs
• Paid Time Off and Paid Sick Leave

Company Description

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.