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Claims Processor

nTech Solutions, Inc. • Fairfax, VA

Posted 2 months ago

Job Snapshot

Degree - High School
Healthcare - Health Services
Information Technology, Customer Service

Job Description

Project Duration

  • Contract-to-Hire, 3 Months

Project Scope

  • Resource needed to process medical claims adjustments and file corrections for member accounts.


  • Provides timely and accurate processing and adjudication of claims.
  • Researches and processes simple claims adjustments and file corrections for member accounts, which may involve various company products, such as indemnity, PPO, HMO, POS, Individual Market, FEP, Dental, vision, etc.
  • 50% Examines claims to identify key elements and processing requirements based on diagnosis, provider, paykey, medical policy, contracts, and policies and procedures.
  • Efficiently and accurately processes product- or system-specific claims to ensure timely payments are generated.
  • Calculates deductibles and maximums, as well as researches and resolves system pends.
  • 30% Processes lower dollar volume claims adjustments in accordance with standard policies and procedures to resolve over and underpayments.
  • 10% Assists Customer Service Reps by providing feedback and resolving issues and answering basic processing questions.
  • 10% Gathers productivity data and compiles weekly and monthly reports on own performance.
  • Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design, financial planning, etc.
  • Work is frequently and closely supervised and audited for quality assurance.
  • Standards for productivity are lower than higher Claims Processor levels, and more training is provided.
  • Makes lower dollar volume claims adjustments.
  • Work is product or system specific.

Job Requirements

Required Skills

  • High school degree plus demonstrated work experience beyond high school.
  • Medical Claims Processing experience for medical, dental, vision.
  • Ability to diagnose codes.
  • Understanding of medical billing.
  • Demonstrated mathematical, problem-solving, data entry/PC, stress management, and organizational skills.
  • Basic written/oral communication skills.
  • CPT/ICD 9 experience required.
  • Medical Claims background with LuminX experience required.
  • Knowledge of Medical terminology required.

Preferred Skills

  • Claims processing, billing, or medical terminology experience.
  • Excel Experience preferred.

nTech is an equal opportunity employer. All offers of employment are contingent upon pre-employment drug and background screenings. Only candidates who meet all of the above client requirements will be contacted by a recruiter.

Job ID: 13847_MB
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