Processor, Claims II Position Available In Horry, South Carolina
Tallo's Job Summary: Processor, Claims II is responsible for reviewing and adjudicating complex or specialty claims, deciding whether to return, deny, or pay claims in accordance with organizational policies. This role also involves training new staff members and ensuring claims are processed accurately and efficiently. The position requires a High School Diploma or equivalent, with 2 years of experience in claims processing. Preferred qualifications include 5 years of experience in processing and adjudicating claims.
Job Description
Description Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.
- 70% Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctly.
- 15% Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
- 15% Researches and resolves claims edits and deferrals.
Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicable.
Additional Skills & Qualifications Requirements:
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Required Education:
High School Diploma or equivalent
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Required Work Experience:
2 years of experience processing, researching and adjudicating claims.
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Preferred Work Experience:
5 years-of experience processing and adjudicating claims. Experience Level Entry Level
