Claims Processor I

Job Description

REQUIREMENTS

• 3+ years of experience in claims processing, medical billing, or healthcare administration
• Experience in high-production environments with monitored quality metrics
• Strong analytical skills to identify discrepancies and investigate root causes
• Proficiency navigating multiple systems and tools simultaneously
• High level of professionalism and discretion regarding sensitive health and financial information
• Ability to work independently in a remote environment
• Exceptional attention to detail and commitment to accuracy
• Exposure to claims processing platforms or healthcare operations systems

RESPONSIBILITIES

• Identify and enter basic procedure codes, diagnosis codes, and claims information
• Validate claim data for completeness and follow up on missing information
• Review claim documentation to ensure alignment with company policies
• Flag discrepancies or unusual information to senior processors or supervisors
• Maintain accurate work records, notes, and documentation within claims systems
• Uphold confidentiality and compliance requirements, including HIPAA
• Participate in training sessions and collaborate with peers in huddles
• Review internal audit results and take corrective steps to improve accuracy

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