Overview
Remote
Depends on Experience
Contract - W2
Contract - Independent
Skills
Healthcare
Claims
Claim
MS Office
Health Care
Auditing
Reporting
Job Details
Title: Claims Processor
Location: Remote
Job Discription:
Each associate is responsible for validating members Out-of-Pocket Maximum (OOPM) cost shares based on the audit years provided in the Accumulator Overages Report. The process involves reviewing the members responsibilities according to their plan benefits and ensuring that OOPM limits and any overages are accurate, following the preset criteria established by Centene. If a member has exceeded their OOPM limit, the excess amount will be reimbursed directly through medical claims and pharmacy reimbursements.
- 1-3 Years of experience in claims processing
- Good logical thinking ability
- Knowledge of US Healthcare Industry
- Should have exposure to MS Office
RESPONSIBILITY:
- Adjudication/Adjustments of claims with zero errors
- Completion of claims in queue within specified time frame
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.