Claims Processor II
Palmetto GBA
full-time
Posted on:
Location Type: Hybrid
Location: Columbia • South Carolina • United States
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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
- Medicare Part B experience is 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 & Tools
claims processingclaims adjudicationcoding proceduresdiagnosis codesquality standardsproduction standardserror correctionclaims researchbusiness math
Soft Skills
organizational skillsanalytical skillsjudgment skillsoral communicationwritten communicationdiscretion
Certifications
High School Diploma