Claims Processor (Healthcare Insurance)

TL;DR

Claims Processor (Healthcare Insurance): Screening, reviewing, and adjudicating paper and electronic healthcare claims with an accent on accuracy, quality control, and benefit eligibility determination. Focus on resolving claim edits, researching inquiries, and ensuring timely payment according to organizational policies.

Location: Working at Home - Pennsylvania (USA)

Company

hirify.global is a leading healthcare insurance provider dedicated to improving health outcomes.

What you will do

• Process and verify claims data to ensure all information is complete and correct.
• Resolve claim edits, review history records, and determine benefit eligibility.
• Determine final payment levels based on benefit reviews and payment standards.
• Maintain professional communication with internal and external customers to resolve issues.
• Meet production and quality standards while maintaining accurate timekeeping records.

Requirements

• High School Diploma or GED.
• Minimum 1 year of related experience.
• Must be based in Pennsylvania.
• Proficiency in administrative and clerical procedures, including word processing and file management.
• Ability to use mathematics for claims adjudication and analyze critical data.

Nice to have

• 1 year of specific claims processing experience.
• Experience with OCWA, Oscar, and Outlook.

Culture & Benefits

• Flexible work-from-home arrangement for residents of Pennsylvania.
• Commitment to a diverse and inclusive workplace with equal opportunity for all.
• Structured environment adhering to HIPAA and ethical business conduct standards.