Claims Processor
Not Disclosed•Full-TimeOn-site
location_onNorth Stanton Street, Downtown Historic District, El Paso, El Paso County, Texas, 79901, United States
About the Role
As a Claims Processor, you will play a pivotal role in ensuring the efficiency and accuracy of claims processing within our organization. This position is designed to maintain the integrity of our claims records while navigating complex regulatory landscapes.
Your day-to-day work involves a dynamic mix of tasks, from overseeing year-end processing activities to managing high-dollar claims and subrogation cases. You will serve as a critical link in the claims lifecycle, handling Medicaid claims, complex appeals, and conducting hospital audits to ensure strict compliance with contractual agreements and regulatory requirements. Success in this role requires a balance of analytical problem-solving and meticulous attention to detail, particularly when resolving escalated issues under pressure.
Work location
Work model: On-site
North Stanton Street, Downtown Historic District, El Paso, El Paso County, Texas, 79901, United States
El Paso, Texas
Key Responsibilities
- check_circleOversee and facilitate year-end processing activities to ensure timely closure of claims records
- check_circleProcess adjustments to claims while ensuring proper documentation and adherence to company policies
- check_circleManage coordination of benefits for claims
- check_circleHandle subrogation and high-dollar claims with attention to detail and sound judgment
- check_circleProcess Medicaid claims and assist in handling complex appeals
- check_circleConduct hospital audits to ensure compliance with contractual agreements and regulatory requirements
- check_circleAnalyze case management reports and ensure they are filed to the correct member
Requirements
- verifiedBachelor's degree preferred, experience considered in lieu of degree
- verifiedMinimum of 1-3 years of experience in claims processing or related field
- verifiedStrong understanding of claims processing procedures
- verifiedFamiliarity with medical terminology and insurance policies
Nice to Have
Bachelor's degree (experience considered in lieu of degree).
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Skills, education and keywords
Skills: Claims Processing, Year-End Processing, Adjustments Management, Coordination Of Benefits, Subrogation, Medicaid Claims, Hospital Audits, Case Management Reports, Medical Terminology, Insurance Policies.
Education: Bachelor's degree preferred, experience considered in lieu of degree.
Frequently asked questions about Claims Processor at National Health Care Solutions
What does a Claims Processor at National Health Care Solutions do?expand_more
Day-to-day, the Claims Processor at National Health Care Solutions will oversee and facilitate year-end processing activities to ensure timely closure of claims records; process adjustments to claims while ensuring proper documentation and adherence to company policies; manage coordination of benefits for claims; and handle subrogation and high-dollar claims with attention to detail and sound judgment.
What are the requirements for this Claims Processor role?expand_more
To qualify for the Claims Processor at National Health Care Solutions position, applicants should have: Bachelor's degree preferred, experience considered in lieu of degree; Minimum of 1-3 years of experience in claims processing or related field; Strong understanding of claims processing procedures; and Familiarity with medical terminology and insurance policies.
Where is the Claims Processor role at National Health Care Solutions located?expand_more
Claims Processor at National Health Care Solutions is based in North Stanton Street, Downtown Historic District, El Paso, El Paso County, Texas, 79901, United States. This is a on-site role.
Is this Claims Processor job remote, hybrid, or on-site?expand_more
National Health Care Solutions has listed this Claims Processor role as on-site.
How much experience is required for this Claims Processor role?expand_more
Claims Processor at National Health Care Solutions typically requires 1–3 years of relevant experience at the mid level level.
What skills do you need for the Claims Processor role at National Health Care Solutions?expand_more
Key skills for Claims Processor at National Health Care Solutions include Claims Processing; Year-End Processing; Adjustments Management; Coordination Of Benefits; Subrogation; Medicaid Claims; Hospital Audits; and Case Management Reports.
What education is required for Claims Processor at National Health Care Solutions?expand_more
Educational requirements for this role: Bachelor's degree preferred, experience considered in lieu of degree.
What category does the Claims Processor role belong to?expand_more
Claims Processor at National Health Care Solutions is part of the accounting & finance job category on Recrutus.