Claims Processor

Job Description

• Analyzes and adjudicates routine claims, determining approval on file, eligibility, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
• Responds to routine phone inquiries and written correspondence related to claim processing issues and/or needs.
• Screens and routes complex claims to claim manager.
• Proofs claim, review, and apply appropriate guideline, coding, member identification, and processes in appropriate turn-around-time.
• Facilitates training in accordance with operational guidelines and manages claims assignment
• Navigates multiple systems to obtain necessary data to adjudicate claims appropriately.
• Ensure payments and/or denials are made in accordance with company practices and procedures.
• Collaborates with customer service team requesting and/or providing feedback and follow up to assist in treatment as well as claims authorization.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.

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https://insightglobal.com/workforce-privacy-policy/. Skills and Requirements - Previous Claims / Insurance experience - Strong computer skills