Foreign Claims Processor

Job Description

REQUIREMENTS

• High School Diploma or GED or equivalent experience.
• U.S. citizenship is required for this position due to Department of Defense restrictions
• One (1) or more years of experience in a claims processing role.
• Demonstrated proficiency in data entry with a strong ability to maintain focus and accuracy.
• Ability to effectively utilize available resources to further research and verify claims.
• Strong written communication skills.
• Demonstrates the ability to work independently and take initiative.

Preferred

• Ability to translate a foreign language.
• Two (2) or more years of prior health insurance experience, i.e., Claims Processor, Customer Service Representative, or Billing Representative preferred.

RESPONSIBILITIES

• Process all MH overseas claim types by determining corrective action to be taken on various types of errors pended by edit system and resolving interactive edits.
• Translate, research, and verify claims information to determine if all requirements have been met.
• Review submitted claim information and select correct procedure code and diagnosis code using ICD-9, ICD-10, CPT4, and HCPCS manuals.
• Obtain development information from external contacts and add successful development information to notepad via PC.
• Access patient/sponsor files and update information accordingly.

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