Claims Processor, Advanced (First Pass-Rework)

Your Role 

The Commercial First Pass Claims and Rework teams are responsible for processing work in enrollment, claims, provider, or other operational areas to meet operational, financial, and service requirements including timely and proper enrollment, adjudication of claims, or provider demographics updates in accordance with contractual requirements. The Claims Processor, Advanced will report to a Claims Operations Supervisor. In this role you will review and adjudicate complex/specialty paper/electronic claims and determine whether to return, deny, or pay claims following organizational policies and procedures, and may provide guidance or expertise to less experienced claims processors.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work 

In this role, you will: 

• Be proficient in front and back-end processing

• Process multiple claim types or specialties

• Act as a Subject Matter Expert (SME) with one product cross functionally

• Possess a solid understanding and knowledge of system processing with the ability to not only identify errors but to analyze and resolve them

• Act as back-up for lead role Mentors associate and intermediate level rep 

• Make or receive calls regarding claims processing questions and clarifications and provide excellent customer service

• Understand fundamentals of end-to-end (life of a clam) claims processing 

Your Knowledge and Experience 

• Requires a High School Diploma or GED

• Requires at least 5 years of prior relevant experience

• Minimum years of 2 years of backend claims processing preferred 

• Experience with Microsoft office, including Microsoft Excel

• Ability to process calculations for claims processing

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.