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Claims Representative

Claims Representative

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Job Description

Project worker. utilize the system and Excel. Reviewing Claim Denials. This is a Production and Project Based position. Putting in claims numbers, determining why a claim was denied. Determining if a claim was paid correctly or not. Researching claim denials.

Background: Claims (Medicaid or commercial). Any type of Healthcare Insurance or Medical Billing background would be good. Anywhere from 2-3 years of experience would be ideal.

Job Requirements


� Knowledge of medical terminology, CMS claims coding guidelines, and Provider Contracts � Comprehensive knowledge of healthcare customer service

� Good MS Office knowledge (Outlook, Word, and Excel)

� Ability to type 40 WPM

� Strong organizational skills

� Excellent problem-solving skills

� Ability to work in multi-disciplinary teams and the ability to perform independently while handling multiple projects simultaneously

� Excellent verbal and written communication skills

� Ability to maintain attendance to support required quality and quantity of work

� Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

� Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers

 Required Education:  High School Diploma or equivalent GED                                                                             

Required Experience:      0-2 years experience in a managed care setting. CPT and ICD-9 coding, data entry, and 10-Key experience.

Job Snapshot

Employment Type Contractor
Job Type Accounting
Education High School
Experience 2 to 7 years
Manages Others No
Relocation No
Industry Healthcare - Health Services
Required Travel Not Specified
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Claims Representative

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