Insurance Claims Processor

🔥 18 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 11%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• Determine accuracy and completeness of claim information • Enter and verify claims data • Resolve claim edits and review history records • Determine benefit eligibility for services • Review payment levels and make final payment determinations • Meet production and quality standards while maintaining work queues • Communicate with internal and external staff • Escalate issues to the appropriate level of supervision • Ensure accuracy of entered data and record maintenance • Attend required training and demonstrate proficiency • Perform other duties assigned by the Claims Manager

🎯 Requirements

• High School diploma/GED • One (1) year of experience working with medical or institutional claim data entry OR One (1) year of customer service experience • Ability to sit for extended periods of time • Working knowledge of administrative and clerical procedures and systems such as word processing and managing files and records • Ability to take direction and navigate through multiple systems simultaneously • Excellent written and oral communication, customer service, interpersonal skills, and telephone etiquette • Ability to solve problems with predefined methods and guidelines • Ability to use mathematics to adjudicate claims • Ability to understand medical insurance requirements for payment and basic knowledge of covered services • Knowledge and understanding of medical terminology, third party payors and insurance preferred • Attention to detail, organization, and ability to perform multiple tasks simultaneously • Proficiency with Microsoft Office Professional Suite, Internet Explorer, and EPIC