Claims Processor I

Healthone Alliance

Competitive salary; not specified; benefits: 401k ...
Accurate claims processing within guidelines
Interpret benefit and policy provisions
Apply standard medical coding logic
The Claims Processor I is responsible for accurate and timely processing of medical professional claims pended for manual adjudication

Job Summary

  • The Claims Processor I is responsible for accurate and timely processing of medical professional claims pended for manual adjudication.
  • The incumbent must meet quality and productivity standards while interpreting benefit and policy provisions applicable to fully-insured plan members.
  • HealthOne offers a comprehensive benefits package including 401K with immediate vesting, health insurance, and paid time off.

Matching Summary

The Claims Processor I is responsible for accurate and timely processing of medical professional claims pended for manual adjudication.

Salary

Competitive salary; Not specified; Benefits: 401K (4% Match), Health & Wellness Program, Paid Time Off

Skills & Requirements

Must-have

  • Accurate claims processing within guidelines
  • Interpret benefit and policy provisions
  • Apply standard medical coding logic

Nice-to-have

  • Integrity and heart to embody values
  • Team player with positive attitude
  • Continuous improvement mindset

Key Requirements

  • High School Diploma or GED required
  • Knowledge of ICD-10, CPT4, DRG, HCPCS codes
  • One year experience in claims processing preferred
  • Compliance with HIPAA regulations

Work Rights

Not specified

Tailored Resume

Cover Letter