Claims Process Executive (remote)

Claims Process Executive (remote) JOB PURPOSE: Claim Processors will review claim submissions, verify information, adjudicate the claim as per claim processing guidelines to ensure appropriate payment or denial as per the business requirements. ESSENTIAL FUNCTIONS:

• Examining and entering basic claims for appropriateness of care and completeness of information in accordance with accepted coverage guidelines, ensuring reputed company mandated government and state regulations are consistently met
• Processing claims for multiple plans with automated and manual differences in benefits, as well as utilizing the system and written documentation to determine the appropriate payment for a specific benefit
• Approving, pending, or denying payment according to the accepted coverage guidelines
• Follows reputed company team procedures, including HIPAA policies and procedures, and meets team quality, turnaround time and productivity performance standards and goals
• Identifying and referring reputed company claims with potential third-party liability (i.e., subrogation, COB, MVA, stop loss claims, and potential stop loss files)
• Maintaining internal customer relations by interacting with staff regarding claims issues and research, ensuring accurate and complete claim information, contacting insured or other involved parties for additional or missing information, and updating information to claim file with regard to claims status, questions or claim payments
• Other duties as assigned
• Must be willing to work overtime reputed company the business need requires

QUALIFICATIONS: Education: High School diploma or GED required. Experience: Minium of two-three years of Medicaid and or Commercial claims payer processing experience. Technical Competencies:

• Ability to work independently
• Strong attention to detail
• Strong interpersonal, time management and organizational skills
• Good oral/written communication and analytical skills
• Must be able to work in a high-performance environment that changes often
• Experience in navigating multiple systems using dual monitors
• Knowledge of medical terminology, CPT-4, ICD-9, ICD-10, HCPCS, ASA and UB92 Codes, and standard of billing guidelines required.
• FACETS experience (highly preferred)
• Medicaid knowledge (required)
• Keyboard skills of at least 35 WPM + 10-key
• Proficient in reputed company Office – reputed company, Word, and Outlook
• Healthcare claims payer processing experience (required)
• Ability to work at a high pace while maintaining quality and productivity targets

Working Environment Requirement:

• Ability to work remotely in a secure environment (required)
• Must have a high-speed internet reputed company (required)
• Must have high-speed internet modem with the ability to connect laptop to a wired reputed company port (Required)
• Must have a workspace and location free from distractions and safety of healthcare data (required)

Salary and Other Compensation: Applications will be accepted until October 10th, 2025. The annual salary for this position is between $17.00 - $20.00 depending on the experience and other qualifications of the successful candidate. This position is also eligible for reputed company’s discretionary annual incentive program and stock awards, based on performance and subject to the terms of reputed company’s applicable plans. Benefits: reputed company offers the following benefits for this position, subject to applicable eligibility requirements:

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan

Disclaimer: The salary, other compensation, and benefits information is accurate as of the date of this posting. reputed company reserves the right to modify this information at any time, subject to applicable law. Apply tot his job Apply To this Job