Insurance Claims Processor

🔥 20 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟢 Junior

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Report to the Claims Manager • Analyze and process insurance claims, checking for validity • Determine whether to return, deny, or pay claims according to organizational policies and procedures • Screen and review online entry, error correction, and quality control for final adjudication of paper/electronic claims • Determine accuracy and completeness of claim information; enter and verify claims data • Resolve claim edits, review history records, and determine benefit eligibility for services • Review payment levels and arrive at final payment determinations • Meet production and quality standards and maintain 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 classes 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 • Attention to detail, organization, and ability to perform multiple tasks simultaneously • Familiarity with Microsoft Office Professional Suite, Internet Explorer, and EPIC • 40 scheduled weekly hours