Claims Processor

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Job Title: Claims Processor

Location(s): Fairfax, VA (Remote)

Purpose:

Essential Functions:

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

• 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:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• Education Level: High School Diploma or GED
• Experience: less than one year experience processing claim documents

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
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, age, protected veterans or individuals with disabilities.