Humera - Administrative and Professional Staffing

Claims Processor IV

Location
Minnetonka, MN, USA
Salary
Contact For Rate
Posted
Feb 11, 2017
Closes
Feb 22, 2017
Category
Customer Service
Job Type
Employee
Employment Status
Full Time
Humera is seeking a Claims Processor IV candidates for our client in Minnetonka, MN. The Claims Processor IV is the expert resource in terms of claims coding, system capabilities, recommended system application and the implementation of benefits and reimbursement policies for all business segments. This is a Contract to Hire opportunity!
Duties:
  • Responsible for reviewing and processing complex provider appeals
  • Serve as the first point of contact experts for claims coding and processing issues related to HealthRules, iCES, deductible/out-of pocket accumulators, provider claims histories, check void/replacement, based on a variety of inter and intra-departmental needs
  • Assist in the training and auditing of new hires
  • Serve as a tester and auditor for new HealthRules enhancements
  • Provide recommendations for claims enhancements or process improvements for claims processing
  • Responsible for reviewing Policy and Procedure documents to ensure they are current and accurately reflect claims processing requirements

Requirements:
  • High School degree, or equivalent
  • Completion and active use of CPC certification within the last 2 years
  • Strong written and verbal communications skills
  • Positive and respectful
  • Collaborative
  • Ability to identify trends and clearly articulate them
  • Knowledge and understanding of Medica products
  • High ethical standards

Schedule:
  • Monday - Friday 8AM - 5PM or Monday - Friday 8:30AM - 5:30PM