Claims Processor

A large healthcare company in Fairfax, VA has an immediate need for a Claims Processor!

Claims Processor I responsibilities:
* Provides timely and accurate processing and adjudication of claims. Researches and processes simple claims adjustments and file corrections for member accounts, which may involve various company products, such as indemnity, PPO, HMO, POS, Individual Market, FEP, Dental, etc.
* 50% Examines claims to identify key elements and processing requirements based on diagnosis, provider, paykey, medical policy, contracts, and policies and procedures. Efficiently and accurately processes product- or system-specific claims to ensure timely payments are generated. Calculates deductibles and maximums, as well as researches and resolves system pends.
* 30% Processes lower dollar volume claims adjustments in accordance with standard policies and procedures to resolve over and underpayments.
* 10% Assists Customer Service Reps by providing feedback and resolving issues and answering basic processing questions.
* 10% Gathers productivity data and compiles weekly and monthly reports on own performance. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design, financial planning, etc.
* Work is frequently and closely supervised and audited for quality assurance. Standards for productivity are lower than higher Claims Processor levels, and more training is provided. Makes lower dollar volume claims adjustments. Work is product or system specific

* Required: High school degree plus demonstrated work experience beyond high school
* Abilities/Skills: Demonstrated mathematical, problem-solving, data entry/PC, stress management, and organizational skills. Basic written/oral communication skills
* Preferred: Claims processing, billing, or medical terminology experience
* The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs
* The physical demands described here are representative of those that must be met by an employee to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.The employee is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The employee must frequently talk and hear. Weights of up to 25 pounds are occasionally lifted.

Equal Opportunity Employer


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Reference number US_EN_99_027071_487623