Claims Processor II
CGS Administrators, LLC
full-time
Posted on:
Location Type: Hybrid
Location: Nashville • Tennessee • 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
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Applicant Tracking System Keywords
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Hard Skills & Tools
claims processingclaims adjudicationcoding proceduresdiagnosis codesquality standardsproduction standardsmathematical conceptsstatistical conceptsdata entryerror correction
Soft Skills
organizational skillsanalytical skillsjudgment skillsoral communicationwritten communicationtime managementdiscretionattention to detailmentoringproblem-solving