Healthcare Claims Processor

We're seeking dedicated Claims Examiners to join our dynamic team in Tampa. No prior experience is required; we're committed to providing comprehensive training to individuals with a strong work ethic and a thirst for knowledge. This is an exceptional opportunity to embark on a new career path and become proficient in a specialized field. Join us if you're ready to unleash your potential and achieve greatness! Position Overview: As a Claims Examiner, you'll play a pivotal role in analyzing and adjudicating various types of claims, including facility, professional, inpatient, and outpatient services. Your responsibilities will include ensuring compliance with industry standards and regulations, as well as identifying opportunities for process improvement within the claims department. Key Responsibilities: Analyze and adjudicate a diverse range of claims, adhering to CMS rules and internal criteria.
Review claims across different lines of business, such as Medicare, Medicaid, and Commercial services, ensuring contract adherence and timeliness guidelines.
Authorize claim payments within established limits or escalate to the Claims Manager when necessary.
Process refunds, appeals, disputes, and adjustments as required.
Proactively identify process improvement opportunities and recommend system enhancements.
Undertake any additional responsibilities assigned by management.
Requirements: Education: High School Diploma or equivalent.
Experience: While preference is given to candidates with at least one year of experience in healthcare claims or claims processing, we're open to training individuals without prior experience.
Technical Skills / Qualifications:
Understanding of health claims processing and adjudication.
Proficiency in basic to intermediate mathematical computations.
Familiarity with medical terminology, ICD-9 & ICD-10 coding.
Basic MS Office computer skills.
Ability to work independently or collaboratively in a team.
Strong time management, written and verbal communication, and attention to detail.
Demonstrated sound decision-making skills.
Compensation and Benefits: Salary: $15.00 - $18.00 per hour based on experience.
Benefits:
Dental, health, and vision insurance.
Performance and referral bonuses.
Paid time off (PTO).
401K Savings Plan.
Flexible hours and the opportunity for remote work for candidates who demonstrate self-discipline and performance under limited supervision.
Unlimited opportunities for upward mobility with leaders promoted from within the organization.
Job Type: Full-time Schedule: 8-hour shift, Monday to Friday, flexible schedule. Work Location: Hybrid remote in Tampa, FL 33618 Ability to Commute/Relocate: Candidates must be located in or willing to relocate to Tampa, FL 33618.
Employment Type: Full-Time
Salary: $ 15.00 18.00 Per Hour