Claims Processor II
CGS Administrators, LLC
full-time
Posted on:
Location Type: Remote
Location: Hawaii • South Carolina • United States
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Salary
💰 $13 - $24 per hour
About the role
- 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
- 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
- Ensures that claims are processing according to established quality and production standards
- Corrects processing errors by reprocessing, adjusting, and/or recouping claims
- 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
Requirements
- High School Diploma or equivalent
- 2 years of experience processing, researching and adjudicating claims
- Strong organizational, analytical and judgment skills
- Strong oral and written communication skills
- Proficient in spelling, punctuation and grammar
- Proficient in basic business math
- Ability to handle confidential or sensitive information with discretion
- Microsoft Office proficiency
- 2 years of claims processing experience preferred
- Strong time management skills preferred
- Knowledge of mathematical and statistical concepts preferred
- Proficient in word processing and spreadsheet applications preferred
- Proficient database software skills preferred
Benefits
- Subsidized health plans
- Dental and vision coverage
- 401k retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingclaims adjudicationcoding proceduresdiagnosis codesdata entryerror correctionresearch skillsanalytical skillsbusiness mathstatistical concepts
Soft skills
organizational skillsjudgment skillsoral communicationwritten communicationtime managementdiscretionmentoringproblem-solving
Certifications
High School Diploma