Claims Processor I

DUTIES: Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.

ESSENTIAL JOB RESPONSIBILITIES:

• 60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
• 25% Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.
• 10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
• 5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

QUALIFICATIONS FOR THE ROLE
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
ccommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Level: High School Diploma or GED
Experience: less than one year experience processing claim documents

Top 5 Requirements: 2+ years claims experience is required. Ability to recognize, analyze, and solve a variety of problems. Detailed in nature, exposure to health care, health insurance, medical information, and direct service experience is preferred.

Preferred Qualifications
1-3 years Claims processing, billing, or medical terminology experience

Knowledge, Skills and Abilities (KSAs)
Demonstrated analytical skills, Proficient
Demonstrated reading comprehension and ability to follow directions provided, Proficient
Basic written/oral communication skills , Proficient
Demonstrated ability to navigate computer applications , Proficient

**Talteam Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.**