Claims Processing Representative

Role Overview

• 2 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically
• Performs varied activities and moderately complex administrative/operational/customer support assignments
• Performs computations
• Typically works on semi-routine assignments
• Determines whether to return, deny, or pay claims following organizational policies and procedures
• Works within defined parameters to identify work expectations and quality standards
• Follows standard policies/practices that allow for some opportunity for interpretation/deviation

Requirements

• Analytical thinking skills and comfortable working independently and with minimal supervision
• Prior experience working with multiple computer systems at a time and multitasking through those effectively
• Ability to manage multiple or competing priorities, including use of multiple computer applications simultaneously
• Excellent verbal and written communication skills
• Proficiency in all Microsoft Office: Word, PowerPoint, Excel
• 1+ years of experience within the healthcare and/or insurance industries
• Customer service experience
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• CAS Claims processing experience
• Bachelor's Degree

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance
• many other opportunities