Job Description
Job Title: Claims Processor (Non-Voice / Back Office)
Work Location: Tampa FL (Remote)
Type: Fulltime
Qualification
- High School Graduate
Experience
- Minimum 5 years of experience in Claims Processing
- Minimum 3 years of hands-on experience with:
- Medicare & Medicaid claims
- Adjustments and Disputes (Appeals)
- Medical Coding
- UB04 & CMS1500 forms
- Problem-solving claims calculations (Benefit / Out-of-Pocket)
Candidate Specification
- Comfortable working from office
- Typing speed of 25 WPM with 90% accuracy
Process Details
- 5-day working schedule
- Good typing speed required
Please Note
- Candidates must be available onsite in the Tampa office for the first 8 weeks for training.
- After successful completion of training, the role transitions to remote (work from home).
- Ensure candidates meet the minimum 3 years of claims processing experience with the required skill areas mentioned above.
Principal Responsibilities
- Medical Claims Processing: Accurately review, verify, and process insurance claims following company policies and SOPs.
- Documentation Review: Analyze claim documents, medical records, and benefit summaries to determine eligibility and process claims accordingly.
- Customer and Internal Business Partner Interaction: Communicate with members, healthcare providers, and internal teams to resolve claims or gather additional information.
- Data Entry: Enter claim details and maintain accurate records in the claims management system.
- Continuous Improvement: Identify and implement process improvements to enhance accuracy and efficiency.
Critical Skills Required
- Strong computer skills, including proficiency in MS Office.
- Excellent verbal and written communication skills.
- Strong interpersonal skills and ability to work collaboratively in a team environment.
- Expert knowledge of the Healthcare domain with a focus on claims processing.
- Experience in Government Operations (Medicare and Medicaid).
- Strong understanding of insurance terminology: Copay, Coinsurance, Deductible, and Out-of-Pocket.
- Ability to explain Medicare and Medicaid eligibility in detail.
- Experience as a Claims Examiner Level III for at least 3 years.
- Knowledge of Corrected Claims Processing, CPT and HCPCS codes.
- Ability to understand California claims contract language.
- Basic mathematical and analytical skills for claims benefit/out-of-pocket calculations.
- Ability to coordinate benefits with Medicare and Medicaid.
Thanks & Regards
Misam Raza
Sr. Talent Acquisition Specialist
Diverse Lynx| 300 Alexander Park Suite| #200|Princeton, NJ 08540
Mobile- 732-582-8414
Office- 732-452-1006 , Ext:285
Email- misam.raza@diverselynx.com | URL- https://www.diverselynx.com/
LinkedIn- linkedin.com/in/connect2misam