Humera - Administrative and Professional Staffing

Claims Processor IV

Minnetonka, MN, United States
Contact For Rate
Apr 25, 2017
May 02, 2017
Job Type
Employment Status
Full Time
Claims Processor IV:
Humera is seeking a Claims Processor IV 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. They provide coding expertise to claims processors and internal customers on the policies administrated by HealthRules or iCES. They collaborate and consult with the Coding Consultants, Auditors, Claims Management Teams and the Operations Analysts at UHG to ensure proper system implementations and claims processing. This is a Contract to hire opportunity!
  • Reviewing and processing complex provider appeals AND will serve as the first point of contact expertise 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 and will 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.
  • Work with managers within Operations as well as I.T., Payment Intent, Network Management, Internal Audit, and Finance related to claims processing or implementation of new products or system enhancements.

  • High School degree, or equivalent
  • Completion and active use of CPC certification within the last 2 years
Desired attributes:
  • 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