Apply Now

Claims Processing Executive -healthcare sector-W2-CANDIATES MUST LIVE IN IOWA

Remote • Posted 15 hours ago • Updated 15 hours ago

Contract W2

12 Months

No Travel Required

Remote

Depends on Experience

Fitment

Dice Job Match Score™

To see how well you match this job, please log in or create an account.

Once logged in, be sure to complete your profile to get the most accurate match score.

🔢 Crunching numbers...

Job Details

Skills

Microsoft Excel
Health Care
Health Insurance
Insurance
Electronic Data Interchange
HIPAA
Management
Customer Satisfaction
Documentation
Communication
Conflict Resolution
Problem Solving
QNXT
Regulatory Compliance
Medicaid
Medicare
Operational Excellence
Authorization
Claims Management
Analytical Skill
Attention To Detail
Auditing
Facets

Summary

Job Summary
Join our team as a Claims Processing Executive in the healthcare sector where you will utilize your expertise in MS Excel to efficiently manage and process commercial claims. This remote position offers the flexibility of working from home during day shifts allowing you to balance work and personal commitments effectively. Your contributions will directly impact the accuracy and efficiency of our claims processing, enhancing customer satisfaction and operational excellence.
Key Responsibilities-
* Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
* Core platform – QNXT claims experienced - Preferred
MUST HAVE CLAIMS and FACETS experience
* Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
* Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
* Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
* Documentation: Record claim activity, maintain audit trails, and prepare reports for management.
Required Skills & Qualifications-
* High school diploma or equivalent REQUIRED
* Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers).
* 2–4 years of experience in US healthcare claims processing
* Familiarity with claims management software and EDI transactions.
* Excellent analytical, organizational, and communication skills.
* Ability to interpret insurance policies and payer guidelines.
* Detail-oriented with strong problem-solving abilities.
Competencies-
* Regulatory Knowledge – Deep understanding of US healthcare laws and payer requirements.
* Accuracy & Detail Orientation – Ensures claims are processed correctly and efficiently.
* Prodblem-Solving – Resolves claim disputes and denials effectively."
Years of Experience: 2.00 Years of Experience

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.

Dice Id: 10221428
Position Id: 61884-1
Posted 15 hours ago

Contact the job poster

Reshmi Nair

Recruiter @ Tektree Systems Inc.

View Profile

Create job alert

Never miss an opportunity! Create an alert based on the job you applied for.

Similar Jobs

Medicaid Claims QA Analyst(Healthcare)

Remote

•

2d ago

Job Description: Job Title: Senior QA Tester Location: Remote Type: Full Time/W2 with Infinite Computer Solutions Job Description: Role summary: Responsible for claims testing for MMIS health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, designs and develops test plans, ensures quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire lif

Easy Apply

Full-time

$85,000 - $95,000

Data Analyst with Healthcare / QNXT experience

Remote

•

6d ago

We are seeking to hire a Conversion Data Analyst with expertise in Medicare / Healthcare Claims systems, to join our teams working on a new multi-year awards we have within several State Govt clients, modernizing their Medicare/Medicaid systems. These roles are 100% remote. Being a US Cit is required for working on this program. This position pays a strong salary package with full benefits (including choice of healthcare plans, dental, vision, life insurance, 3 weeks PTO, 11 Paid Federal Holida

Easy Apply

Full-time

Depends on Experience

Manager, IT Testing (Claims domain)

Remote or Georgia

•

Today

Job Description Claims Domain Test Manager: Summary: Play the role of Claims Domain test manager for MMIS health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, design and develop test plans, ensure quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in th

Full-time

USD 97,790.00 - 127,000.00 per year

Healthcare NSA Analyst - Remote - Contract

Remote

•

9d ago

Title : Healthcare NSA Analyst Remote Job Type: Contract Project description You will be part of a team responsible for testing healthcare claims processing, benefits, pricing, and related workflows for a non-profit healthcare organization in the US. The role is focused on validating local claims processing within HealthRules Payer (HRP), including EDI transactions, Blue Card claims, and HRP-to-TPA workflows. You will collaborate closely with Product Owners, Business Analysts, Develope

Easy Apply

Contract, Third Party

$65 - $70

Search all similar jobs

Remote jobs at Tektree Systems Inc.