Humera - Administrative and Professional Staffing

Claims Processor II

Location
Minnetonka, MN, United States
Salary
Contact For Rate
Posted
Oct 03, 2017
Closes
Oct 14, 2017
Job Type
Employee
Employment Status
Full Time
    Humera is seeking a Claims Processor II for our client in Minnetonka, MN. This candidate will be responsible for the efficient and accurate processing of medical professional, institutional, dental, vision, and pharmacy claims, The person in this position will be processing approximately 70 claims per day.

    This is a Contract to Hire position.
    Duties:
    Claims Processing 70%
    • Review claims to ensure proper information is on the claim to complete processing
    • Request documentation to finalize claim
    • Identify contract specific situations and manually calculate contract benefits using pricing and out-of-pocket procedures
    • Process claims in adherence with policies, procedures, and other applicable rules as well as claims quality and production standards
    Claims Examination 10%
    • Examine all types of medical, dental and vision claims in accordance with established contractual agreements and benefit plan design
    • Enter claims data information into the claims processing system
    • Review and Repair electronic claims and process adjustments
    Claims Investigation 10%
    • Research and resolve advanced system edits
    • Evaluate and research non-routine claims for processing such as coordination of benefits, medical necessity, and other coverage benefits and resolve system edits
    • Research, investigate, and follow up on necessary benefit policies as indicated in the Certificate of Coverage or Summary Plan Document
    • Research and process or adjust high dollar claims.
    Claims Efficiency 10%
    • Ensure timely and accurate payment or denial of claims or adjustments
    • Perform audits on peers and auto adjudicated claims on a regular basis
    Claims Clerical Documentation <5%
    • Document any additional information or specific action taken using the proper system

    Requirements:
    EDUCATION/EXPERIENCE
    • High School Degree or equivalent with two years or more post-secondary preferred
    • 2 years of experience in a healthcare related setting ; 1 year of IFB related experience (Enrollment/Contact Center/Billing/Finance) preferred
    • Prior healthcare related experience in a payer or medical office/facility environment
    • Demonstrated flexibility to adapt to changes in procedures and job assignments
    • Ability to work independently and seek solutions to problems
    • Prioritization skills in order to schedule work to meet deadlines
    • Well-developed analytical skills to evaluate and determine the appropriate course of action
    • Strong digital computing skills including ability to work in multiple systems and with dual screens.
    • Good reading skills required for following claims procedures
    • Demonstrated ability to analyze detailed information, issues, situations, and procedures to develop effective solutions.
    • Ability to work independently and seek solutions to problems
    • Ability to identify trends and ask good questions to improve processes
    • Ability to follow detailed instructions and make independent decisions
    SKILLS/ABILITIES
    • Written and verbal communications
    • Positive and respectful
    • High ethical standards
    • Self-motivated
    • Possess personal integrity
    • Able to collaborate with a team
    • Sound technical skills, expert analytical ability, and good judgment

    Schedule:
    M - F 8:00 am - 5:00 pm


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