Claims Processing Representative [United States]

 

The Claims Processing Representative 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.

Responsibilities

Claims Processing Representative 2:

• Determines whether to return, deny, or pay claims following organizational policies and procedures

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  Decisions are typically focus on interpretation of area/department policy and methods for completing assignments

• Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction

• Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion

Required Qualifications

• Medical Claims Processing and/or Medical Coding/Billing

• Provider Customer Service experience

• Proficiency in all Microsoft Office -Basic understanding using Word, Excel, and Outlook

Preferred Qualifications

• Medical Coding certification

• Quality background

Additional Information

Hours: Flex Start Time: 6:00 a.m. to 9:00 a.m. EST Monday – Friday with ability to support business as needed for overtime.

Scheduled Weekly Hours

40

Not Specified
0

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