Top 231 Medical claims processor Jobs

Medical Claims Processor I
Detego Health —Omaha, NE
- From $24 an hour
- Full-time
- Background check
- Anatomy knowledge
- Microsoft Excel
- Health insurance
- Dental insurance
Quick Apply
1d
EDI Technical Analyst (Claims) - Hybrid
Blue Cross Blue Shield of Arizona —Phoenix, AZ
- Full-time
- Word processing
- Research
- Mid-level
- Paid holidays
- Health insurance
Copay Claims Processor
TailorMed —Remote
- Mid-level
- High school diploma or GED
- US work authorization
- Paid parental leave
- Paid holidays
Quick Apply
Claims Processor- 100% Remote
MEDLOGIX, LLC —Remote
- $50,000 a year
- Full-time
- Remote
- Mid-level
- Bachelor's degree
- Organizational skills
Quick Apply
Claims Processor
GLOBALHEALTH HOLDINGS LLC —Oklahoma City, OK
- Full-time
- Remote
- Basic math
- HIPAA
- Mid-level
- Health insurance
Quick Apply
Claims Process Documentation & Training Specialist
Centivo —Buffalo, NY
- $75,000 - $80,000 a year
- Full-time
- Remote
- Mid-level
- Office
- 3 years
- Health insurance
- Work from home
Medical Claims Processor I
Moda Health —Milwaukie, OR
- $17.34 - $19.41 an hour
- Overtime
- Medical office experience
- High school diploma or GED
- Typing
- Paid holidays
- Health insurance
Quick Apply
Xcelys Medical Claims Examiner-REMOTE
NTT DATA —Ontario, CA
- $20 an hour
- Contract
- Remote
- High school diploma or GED
- Analysis skills
- Continuous improvement
Quick Apply
Dental Claims Processor I
Moda Health —Milwaukie, OR
- $17.34 - $18.36 an hour
- Weekends as needed
- Hybrid work
- Office
- High school diploma or GED
- Data entry
- Paid holidays
- Health insurance
Quick Apply
Medical Claims COB Processor I
Moda Health —Milwaukie, OR
- $18.39 - $20.58 an hour
- Weekends as needed
- Word processing
- High school diploma or GED
- Continuous improvement
- Paid holidays
- Health insurance
Quick Apply
1099 Pet Claims Processor (Independent Contractor) - Property & Casualty Adjuster License Required (Home State P&C License Required)
Administrative Strategies —Remote
- Temporary
- Bilingual
- Anatomy knowledge
- Microsoft Excel
- Pet insurance
Quick Apply
Experienced Healthcare Claims Processor
Karna, LLC —Raleigh, GA
- $20 - $25 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- 5 years
Associate, Claims Receipt Processor
Ametros Financial —Wilmington, MA
- $20 - $23 an hour
- Full-time
- Hybrid work
- High school diploma or GED
- Organizational skills
- Communication skills
Claims Processor
Zenith-American —Tualatin, OR
- Full-time
- Computer literacy
- Writing skills
- Basic math
- AD&D insurance
- Health insurance
Healthcare Claims Processor
Central Data Services (CDS) —Pittsburgh, PA
- Office
- Entry level
Medical Claims Processor
techgene solutions —Boise, ID
- $29 - $30 an hour
- Contract
- In-person
- Communication skills
- Entry level
Quick Apply
12d
(Remote Part-Time) Instructor - Medical Billing and Coding
ProTrain —Remote
- Part-time
- Remote
- HIPAA
- Mid-level
- 3 years
- Tuition reimbursement
Quick Apply
Customer Service/Processor
Uniters —West Palm Beach, FL
- Full-time
- Computer literacy
- High school diploma or GED
- Analysis skills
- Disability insurance
- Health insurance
Medical Claims Processor
Redirect Health Inc —Phoenix, AZ
- $19.26 - $24.99 an hour
- Full-time
- Hybrid work
- Microsoft Word
- Mid-level
- Office
- Dental insurance
- 401(k)
Quick Apply
3d
Medical Claims Processor Healthcare
Trucking Employees of North Jersey —Elmwood Park, NJ
- $45,000 - $51,000 a year
- Full-time
- Spanish
- Writing skills
- English
- Health insurance
- Dental insurance
Quick Apply
2d

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Medical Claims Processor I

Detego Health -
Omaha, NE

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Job Details

Full-time
From $24 an hour
1 day 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

Refine Your Search

medical claims processor jobs

Medical Claims Processor I

EDI Technical Analyst (Claims) - Hybrid

Copay Claims Processor

Claims Processor- 100% Remote

Claims Processor

Claims Process Documentation & Training Specialist

Medical Claims Processor I

Xcelys Medical Claims Examiner-REMOTE

Dental Claims Processor I

Medical Claims COB Processor I

1099 Pet Claims Processor (Independent Contractor) - Property & Casualty Adjuster License Required (Home State P&C License Required)

Experienced Healthcare Claims Processor

Associate, Claims Receipt Processor

Claims Processor

Healthcare Claims Processor

Medical Claims Processor

(Remote Part-Time) Instructor - Medical Billing and Coding

Customer Service/Processor

Medical Claims Processor

Medical Claims Processor Healthcare

I want to receive the latest job alert for medical claims processor

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