Senior Claims Processor

Highmark Health

Base: $19.66 - $27.42; bonus/equity: not specified...
Screening and reviewing claims
Evaluating online entry
Correcting errors and quality control
Responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims

Job Summary

  • Responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims.
  • Determines whether to return, deny or pay claims following organizational policies and procedures.
  • Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes, etc.

Matching Summary

Responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims.

Salary

Base: $19.66 - $27.42; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • Screening and reviewing claims
  • Evaluating online entry
  • Correcting errors and quality control
  • Final adjudication of claims
  • Determining claim payment or denial
  • Adjusting claims based on information
  • Meeting production and quality standards

Nice-to-have

  • Professional communication with customers
  • Assisting with lead functions
  • Researching and resolving inquiries

Key Requirements

  • 3 years of related experience
  • 1 year of claims processing experience
  • High School Diploma/GED

Work Rights

Not specified

Tailored Resume

Cover Letter