Claims Processor II

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $37.7k - $56.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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Magellan Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $101M Private Equity Round - Magellan Health Services on 2004-01

Healthcare • Healthcare Insurance

Magellan Health is a healthcare organization focused on behavioral health and care-management services. The company provides clinical care managers, military and family life counselors, and behavioral health services across regional programs (e. g. , Magellan Hawai‘i, Magellan of New Mexico), and supports treatment coordination for mental health and substance abuse conditions. It also offers programs that support military families and other institutional clients, indicating work in managed behavioral health and care coordination.

📋 Description

• Process all claims accurately and timely in accordance with claims payment policy and customer/provider contractual agreements • Adjudicate claims and adjustments • Resolve claims edits and suspended claims • Maintain and update reference materials required for claims adjudication • Provide backup support to other team or group members • Manually price claims using various tools and processes • Review daily reference-material updates and share feedback or concerns • Partner with the Quality team on procedures and complex claims • Receive coaching from leadership • Perform additional duties assigned by leadership consistent with the role

🎯 Requirements

• Demonstrated ability to navigate computer applications • Experience with ICD-9/10 codes and Current Procedural Terminology (CPT) • Demonstrated basic analytical skills • Basic written and oral communication skills • Demonstrated reading comprehension and ability to follow provided directions • Claims work experience required • GED or high school education required • Must comply with applicable legal, regulatory, contractual, security, and internal policy requirements

🏖️ Benefits

• May be eligible for short-term incentives • Comprehensive benefits package • Health, life, voluntary, and other benefits • Benefits and perks supporting physical, mental, emotional, and financial wellbeing • Tobacco-free workplace • Equal Opportunity Employer

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