Medical Claims Processor
Posted 2026-05-06
Remote, USA
Full-time
Immediate Start
- Job Description:
- Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.
- Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios.
- Ensure prompt claims processing to meet client standards and regulatory requirements.
- Identify and resolve any barriers using effective problem-solving strategies.
- Collaborate with internal departments to proactively resolve discrepancies and issues.
- Use analytical skills to identify root causes and implement solutions.
- Uphold confidentiality of patient records and company information in accordance with HIPAA regulations.
- Maintain thorough and accurate records of claims processed, denied, or requiring further investigation.
- Analyze and report trends in claim issues or irregularities to management.
- Assist Team Leads with reporting to contribute to continuous process improvements.
- Engage in audits and compliance reviews to ensure adherence to internal and external regulations.
- Critically evaluate and recommend process improvements when necessary.
- Mentor and train new claims processors as needed.
- Requirements:
- High school diploma or equivalent.
- Minimum of five years of experience in medical claims processing, including professional and facility claims, as well as complex and high-dollar claims.
- Familiarity with ICD-10, CPT, and HCPCS coding systems.
- Understanding of medical terminology, healthcare services, and insurance procedures (experience with worker’s compensation claims is a plus).
- Strong attention to detail and accuracy.
- Ability to interpret and apply insurance program policies and government regulations effectively.
- Excellent written and verbal communication skills.
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
- Ability to work independently and collaboratively within a team environment.
- Commitment to ongoing education and staying current with industry standards and technology advancements.
- Experience with claim denial resolution and the appeals process.
- Ability to manage a high volume of claims efficiently.
- Strong problem-solving capabilities and a customer service-oriented mindset.
- Flexibility to adjust to the evolving needs of the client and program changes.
- Benefits:
- 401(k) with employer matching
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Flexible Paid Time Off (PTO)
- Paid Holidays