Claims Processing Executive

Our client, an IT Services and Consulting company, is looking for a Claims Processing Executive for their Remote/IA location.

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.

Requirements:

• 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.
• Regulatory Knowledge - Deep understanding of US healthcare laws and payer requirements.
• Accuracy & Detail Orientation - Ensures claims are processed correctly and efficiently.
• Problem-Solving - Resolves claim disputes and denials effectively.
• Years of Experience: 2.00 Years of Experience

Why Should You Apply?

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities