Top 2 Medical claims processor i Jobs in Omaha, Ne

Medical Claims Processor I
Detego Health —Omaha, NE
- From $24 an hour
- Full-time
- Background check
- Anatomy knowledge
- Microsoft Excel
- Health insurance
- Dental insurance
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2d
Claims Operations Quality Assurance Specialist
Pacific Life Insurance Company —Omaha, NE
- $32 - $43 an hour
- Full-time
- Mid-level
- Office
- Analysis skills
- Paid parental leave
- Paid holidays
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Medical Claims Processor I

Detego Health -
Omaha, NE

Quick Apply

Job Details

Full-time
From $24 an hour
2 days ago

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance

Qualifications

Anatomy knowledge
Microsoft Excel
Professional ethics
Health insurance policy knowledge
Data analysis skills
HIPAA
Research
Bachelor's degree
Business Administration
Productivity software
Medical terminology
Cross-functional communication

Full Job Description

Job Summary
We are seeking a detail-oriented and knowledgeable Medical Claims Processor I to join our team. The Medical Claims Processor I role is a multi-faceted position for the research and processing of healthcare benefits claims for inpatient, outpatient facilities and professional services. This person will use independent judgement and discretion to review, analyze, and make determinations regarding payment, partial payment, or denial of medical claims, as well as various types of invoices, based upon specific knowledge and application of each client’s customized plan(s). The Medical Claims Processor I will record and maintain insurance policies through the Plan Documents and claim information in the database systems and determine policy coverage while calculating claim amounts.

Responsibilities

Analyze, review and adjudicate medical claims in our Healthvue360 and HRP systems
Read, analyze, understand, and ensure compliance with clients’ customized plans
Learn, adhere to, and apply all applicable privacy and security laws, including, but not limited to; HIPAA, HITECH and any regulations promulgated thereto
Independently review, analyze and make determinations of claims for:

- reasonableness of cost;

- unnecessary treatment by physician and hospitals; and

- fraud

Review, analyze and add applicable notes in our Healthvue360 and HRP systems
Review billed procedure and diagnosis codes on claims for billing irregularities
Analyze claims for billing inconsistencies and medical necessity
Authorize payment, partial payment, or denial of claim based upon individual investigation and analysis
Review workflow and release pended claims, if applicable
Review, Pend, and Suspend claim reports to finalize all claim determinations timely
Assist and support other Medical Claim Processors as needed and when requested by leadership
Attend continuing education classes as required, including but not limited to HIPAA training
Review stop loss and notification process
Process claims with a proficiency of 98% or higher of production goals, based on benefit plans worked
Maintain an average of 95% or higher of accuracy of claims processed, tracked as a quality score

Requirements

Experience with overseeing processes and workflow of medical claims analysis
Knowledge of the TPA and health benefits industry
Strong attention to detail and ability to build out operational processes
Superb communication, organizational, and leadership skills
Knowledge of medical terminology and anatomy
PC proficiency to include Microsoft Word and Excel
Ability to multi-task and prioritize
Strong analytical skills and knowledge of computer systems
A natural demonstration of integrity, ethical conduct, and trustworthiness
Ability to communicate ideas effectively and work with a wide range of internal stakeholders, including senior leaders
Respectful to coworkers and conducts himself/herself in work-settings in a manner that is consistent with Detego Health’s core values

Preferred Skills:

Bachelor’s degree in business administration or related field
5+ years industry experience working with national and regional healthcare brands
5+ years data entry experience working in a high-volume production setting

This role is foundational for those seeking to advance in the healthcare and insurance industries, offering valuable experience in claims management and processing.

Pay: From $24.00 per hour

Benefits:

401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance

Work Location: In person

Quick Apply

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medical claims processor i jobs in omaha, ne

Medical Claims Processor I

Claims Operations Quality Assurance Specialist

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