Job Description

Job Title: Claims Processor – USC Only
Location: 100% Remote – must be able to work EST hours Schedule: Must be willing to work schedules between Monday – Friday starting at 5am-5pm
Training will be Monday-Friday 7/8am - 3/4pm (2 weeks)
Start Date: 5/5/25

Responsibilities:

• Reviews processed claims and inquiries to determine corrective action which can include adjusting claims
• Reviews claims to ensure the correct provider or practice is selected
• Takes the corrective action steps using enrollment, benefit and historical claim processing information
• Determine if claim information is complete and correct
• Resolve claim edits, review history records and determine benefit eligibility for service
• Meets all production and quality standards
• Attends all required training classes
• Elevates issues to next level of supervision, as appropriate
• Maintains accurate records, including timekeeping records
• Other duties as assigned or requested

  Qualifications:

• Healthcare insurance experience is required
• High School Diploma/GED
• Good data entry skills
• Customer service experience
• Must have critical thinking skills
• Claims experience is preferred
• Knowledge of Medicaid preferred
• Ability to take direction and to navigate through multiple systems simultaneously
• Knowledge of administrative and clerical procedures and systems such as word processing and managing files and records
• Ability to solve problems within pre-defined methods and guidelines
• MS Office Suite
• Basic computer skills
• Excellent communication skills
• Attentive to detail