Claims Processor II

🕒 4 days ago

🇺🇸 United States – Remote

💵 $37.7k - $56.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Magellan Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

💼 Consulting

🛡️ Insurance

🏥 Healthcare

💰 $101M Private Equity Round on 2004-01

Consulting • Insurance • Healthcare

Magellan Health is a leading healthcare management company that provides a range of services, including behavioral health, pharmacy management, and employee assistance programs. The company focuses on delivering high-quality care and support to individuals and families, particularly those in military and community settings. Magellan Health emphasizes personalized service and innovative solutions to improve health outcomes and enhance the overall patient experience.

📋 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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