Claims Processor

Job not on LinkedIn

🔥 3 hours ago

🇺🇸 United States – Remote

💵 $17 / hour

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

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Sagility

WebsiteLinkedInAll Job Openings

10,000+ employees

📋 Compliance

🔒 Cybersecurity

☁️ SaaS

Compliance • Cybersecurity • SaaS

Sagility is a company focused on digital privacy and online user experience, with an emphasis on cookie management and compliance with EU cookie laws. It provides tools and information for managing cookies, ensuring legal compliance, and enhancing website functionality and user privacy. Sagility aims to help businesses understand site visitors' interactions through necessary and optional cookies while maintaining data protection standards.

📋 Description

• Review medical claims thoroughly to ensure no missing or incomplete information • Navigate multiple computer systems and platforms to research and process assigned claims accurately (e.g., verifying pricing, prior authorizations) • Apply appropriate benefits to each claim in accordance with claims processing policies, including grievance procedures, state mandates, CMS guidelines, and benefit plan documents • Review documentation to assess whether the visit was necessary and whether the policy covers the treatment received • Determine if claims should be paid or denied, and complete denial letters when applicable

🎯 Requirements

• Minimum of one year of recent experience processing medical claims for a health insurance company or payer • Familiarity with medical claim forms (CMS-1500 and UB-04) • Working knowledge of coding systems: ICD-10, HCPCS, and CPT • Proficient in computer navigation and technology, including Microsoft Windows, Excel (advanced functions), and web-based tools and platforms • Excellent verbal and written communication skills • Ability to remain focused and productive in a high-volume, repetitive task environment • High School Diploma or equivalent.

🏖️ Benefits

• Medical, Dental, and Vision coverage. • Life Insurance. • Short-Term and Long-Term Disability options. • Flexible Spending Account (FSA). • Employee Assistance Program. • 401(k) with employer contribution. • Paid Time Off (PTO). • Tuition Reimbursement.