Claims Processor II

Workforce Classification:
Telecommuter
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The Claims Processor II is responsible for the accurate and timely review, research, and resolution of moderately complex claims in accordance with contracts and policies. This may include subrogation, Medicare, and coordination of benefits for dental, medical and hospital claims. Incumbent is responsible for interpreting procedures and policies to ensure accurate claims resolution. Incumbent may also be responsible for processing simple and routine claims.
What you will do:

- Review, process, and resolve moderately complex claims in accordance with contracts and policies.

- Research claims through the utilization of reference materials and on-line tools.

- Responsible for accurately coding claims through the system.

- Translate data into information acceptable to the claims processing system including follow up on pending claims.

- Maintain all appropriate claims files and perform follow-up on pending claims.

- Prepare claims for return to Provider or Subscriber when additional information is needed.

- Demonstrate adjudication proficiency to meet or exceed accuracy goals.

- Consistently meet cycle time/productivity goals that are aligned with corporate objectives.

- Maintain confidentiality of all documents/files.

- Contact other carriers or provider offices as necessary.

- May provide `buddy training' and feedback to new associates.

- May complete adjustments, reversals, and/or refunds.

- Apply commitment to quality by doing things right the first time to avoid defects from reaching customers or requiring internal re-work.

What you will bring:

- High School diploma or GED . (Required

- Six (6) months claims processing experience or customer service experience. (Required)

- Experience with out-of-area program. (Preferred)

- Technical experience of contract benefits, claims processing steps, and correction procedures. (Preferred)

What you will gain:

- Stronger claims processing and research skills.

- Knowledge of contracts, benefits, and claim procedures.

- Experience resolving moderately complex claims.

- Greater accuracy, productivity, and quality expertise.

- Opportunities to support and train new associates.

Physical Requirements:
The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. This role requires the ability to keyboard and to communicate clearly and understandably in person, and over the telephone.
Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

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Medical, vision, and den