Job Details

Your Role

The Commercial First Pass Claims and Rework teams are responsible for processing work in enrollment, claims, provider, or other operational areas to meet operational, financial, and service requirements including timely and proper enrollment, adjudication of claims, or provider demographics updates in accordance with contractual requirements. The Claims Processor, Intermediate will report to a Claims Operations Supervisor. In this role you will review and adjudicate complex/specialty paper/electronic claims and determine whether to return, deny, or pay claims following organizational policies and procedures, and may provide guidance or expertise to less experienced claims processors.

Your Knowledge and Experience

• Requires a high school diploma or GED

• Requires at least 3 years of experience

• Experience with Microsoft office, including Microsoft Excel

• Ability to process calculations for claims processing

• Ability to communicate effectively through email