claims processor

90 Degree Benefits

<p>90 Degree Benefits, a Third Party Administrator (TPA) with offices across the country, is seeking a detail-oriented Medical Claims Processor to join our team. The ideal candidate will have a background in processing medical claims for self-funded clients and possess knowledge of medical terminology.</p><p><b>Responsibilities:</b></p><ul><li>Review and process medical, dental, and vision claims accurately and efficiently</li><li>Interpret and understand Plan Document provisions</li><li>Maintain financial, procedural, and payment standards</li><li>Maintain established production standards</li></ul><p><b>Skills:</b></p><ul><li>Familiarity with medical terminology</li><li>Strong attention to detail and accuracy</li><li>Strong computer keyboard and navigational skills</li><li>Ability to prioritize and manage multiple tasks</li><li>Ability to work independently and in a team environment</li><li>Proficiency in MS Office</li></ul><p><b>Benefits:</b></p><ul><li>Health, dental, vision</li><li>Life and disability</li><li>401(k)</li><li>Paid time off</li><li>11 Holidays</li><li>Online training library</li><li>Defined career path</li><li>Work from home</li></ul><p><b>This position is Full time/Remote</b></p><p>Job Type: Full-time</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Education:</p><ul><li>High school or equivalent (Required)</li></ul><p>Language:</p><ul><li>English (Required)</li></ul><p>Work Location: Remote</p>

Medical Claims Processor

Mokan Sheet Metal Workers Welfare Fund

<p>Provide high-level customer service while accurately processing Medical, Hospital, Dental, and ITS claims. Collaborate effectively with office staff in a team-oriented environment to ensure timely and accurate claim resolution. Maintain professionalism, attention to detail, and compliance with company policies while supporting both internal teams and customers.</p><p>Job Type: Full-time</p><p>Pay: $23.00 - $25.00 per hour</p><p>Benefits:</p><ul><li>Dental insurance</li><li>Employee assistance program</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Retirement plan</li><li>Vision insurance</li></ul><p>Physical Setting:</p><ul><li>Office</li></ul><p>Education:</p><ul><li>High school or equivalent (Preferred)</li></ul><p>Experience:</p><ul><li>Microsoft Office, Word, FACETS: 1 year (Required)</li><li>Customer Service/ FACETS: 1 year (Required)</li><li>Claims processing: 1 year (Required)</li></ul><p>Work Location: In person</p>

Claims Processor

BlueCross BlueShield of South Carolina

<div>
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  Summary
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 Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.
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  Description
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  Logistics:
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 CGS (cgsadmin.com)
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 one of BlueCross BlueShield's South Carolina subsidiary companies.
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  Location:
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 This position is full-time (40-hours/week) Monday-Friday You will work an 8-hour shift scheduled during our normal business hours of 8:00am-4:00pm CST. This role is located at 26 Century Blvd Suite ST610 Nashville, TN 37214.
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   SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
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  What You&rsquo;ll Do
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   Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Verifies that claims have been keyed correctly.
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   Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
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   Researches and resolves claims edits and deferrals. Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Responds to routine correspondence and completes spreadsheet if applicable.
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  To Qualify For This Position, You'll Need The Following
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   Required Education: High School Diploma or equivalent
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   Required Work Experience: 2 years of experience processing, researching and adjudicating claims.
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   Required Skills and Abilities:
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   Strong organizational, analytical and judgment skills.
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   Strong oral and written communication skills.
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   Proficient in spelling, punctuation and grammar.
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   Proficient in basic business math.
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   Ability to handle confidential or sensitive information with discretion.
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   Required Software and Tools: Microsoft Office.
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  We Prefer That You Have The Following
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   Preferred Work Experience: 2 years of claims processing experience.
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   Preferred Skills and Abilities:
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   Strong time management skills.
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   Strong attention to detail skills.
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   Knowledge of mathematical and statistical concepts.
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   Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. proficient database software skills.
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  Our Comprehensive Benefits Package Includes The Following
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 We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
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   Subsidized health plans, dental and vision coverage
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   401k retirement savings plan with company match
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   Life Insurance
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   Paid Time Off (PTO)
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   On-site cafeterias and fitness centers in major locations
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   Education Assistance
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   Service Recognition
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   National discounts to movies, theaters, zoos, theme parks and more
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  What We Can Do For You
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 We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
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  What To Expect Next
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 After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
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  Equal Employment Opportunity Statement
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 BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
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 We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
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 If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
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 We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
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 Some states have required notifications. Here's more information.
</div>


Processor, Claims II

Optum

<div><p><i>This position follows a hybrid schedule with employees will be required to work some days onsite and some days from home. Our office is located at OptumHealth Public Sector, 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108.</i></p><p>
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start <b>Caring. Connecting. Growing together.</b></p><p>
This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will support timely processing of the member's claim.</p><p>
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.</p><p>
We offer 90 days of online and onsite on the job training aligned to your schedule.</p><p><br>
</p><p><b>Primary Responsibilities:</b></p><ul><li>
Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims</li><li>
Analyze and identify trends and provide reports as necessary</li><li>
Consistently meet established productivity, schedule adherence and quality standards</li><li>
Other duties as assigned</li></ul><p><br>
</p><p>You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.</p><p><b>
Required Qualifications:</b></p><ul><li>
High School Diploma / GED OR equivalent work experience</li><li>
Must be 18 years of age OR older</li><li>
1+ years of experience in a related environment (i.e., office, administrative, clerical, customer service, etc.), using phones and computers as the primary job tools</li><li>
Experience using computers and Windows based applications, which includes the ability to learn new and complex computer system applications</li><li>
1+ years of experience using Microsoft Office applications</li><li>
1+ years of experience with processing medical, dental, prescription, OR mental health claims</li><li>
Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.</li></ul><p><br>
</p><p><b>Telecommuting Requirements:</b></p><ul><li>
Reside within commutable distance to the office at OptumHealth Public Sector, 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108</li><li>
Ability to keep all company sensitive documents secure (if applicable)</li><li>
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.</li><li>
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.</li></ul><p><br>
</p><p><b>Soft Skills:</b></p><ul><li>
Ability to work independently and prioritize tasks</li><li>
Display strong work ethic, independence, and dependability</li><li>
Exhibit excellent time management, organizational, and prioritization skills</li><li>
Demonstrate the ability to multitask</li><li>
Possess effective interpersonal, influence, collaboration, and listening skills</li><li>
Drive for results individually and in a team setting</li></ul><p><br>
</p><ul><li>All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul><p><br>
</p><p>Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $17.98 - $32.12 per hour based on full-time employment. We comply with all minimum wage laws as applicable.</p><p><br>
</p><p><i>At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.</i></p><p></p><p><i><br>
</i></p><p><i>UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.</i></p><p><i><br>
</i></p><p><i>UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.</i></p><p><br>
</p><p>#RPO</p></div>

Claims Representative

APCO Holdings

<div><p>APCO Holdings partners with dealerships across North America to deliver innovative vehicle protection products and services that enhance the ownership experience for customers and drive growth for our partners. Through our family of brands, we bring together industry expertise, technology, and data-driven insights to help dealers strengthen their finance and insurance performance and build lasting relationships with their customers.</p>
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Our teams work collaboratively across operations, technology, risk, finance, marketing, and sales to deliver solutions that create measurable value and support the continued growth of APCO and the partners we serve.</p>
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We are looking for a <b>Manager, Claims Payment Processing </b>to lead our claims payment operations team. In this role, you will oversee payment accuracy, team performance, and operational efficiency&mdash;ensuring claims are processed promptly while maintaining strong quality and financial controls.</p><div><br>
</div>
<h3 class="jobSectionHeader"><b>What You'll Do</b></h3><div>
<ul><li>Lead and manage a team of Claims Payment Processors, including coaching, development, and performance management</li>
<li>Oversee claims payment processing to ensure accuracy, timeliness, and compliance</li>
<li>Conduct quality audits on paid claims and identify areas for improvement</li>
<li>Monitor and report on key performance indicators (KPIs) and team productivity</li>
<li>Support monthly reconciliation of claims and vendor disbursement accounts</li>
<li>Investigate and resolve discrepancies, including initiating and managing payment disputes</li>
<li>Handle escalated issues related to payment processing and customer concerns</li>
<li>Allocate work and manage workflow to ensure efficient turnaround times</li>
<li>Serve as a subject matter expert for departmental processes, including timekeeping and operational procedures</li>
<li>Drive process improvements to enhance efficiency, accuracy, and overall performance</li>
</ul></div><h3 class="jobSectionHeader"><b>What Makes You Successful</b></h3><div>
<p>
You&rsquo;ll be successful in this role if you&rsquo;re a detail-oriented leader who thrives in a fast-paced, high-volume environment. You&rsquo;re comfortable managing both people and processes, ensuring that work is completed accurately and efficiently.</p>
<p>
You&rsquo;re also a strong coach and communicator who can develop team members while holding them accountable to performance standards. You bring a problem-solving mindset, proactively identifying issues and implementing improvements to drive better outcomes.</p>
</div><h3 class="jobSectionHeader"><b>
Basic Qualifications</b></h3><div>
<ul><li>Bachelor&rsquo;s degree or equivalent work experience</li>
<li>4+ years of experience in a claims or payment processing environment</li>
<li>Experience leading or supervising a team</li>
<li>Strong organizational and time management skills</li>
<li>Strong communication skills, both written and verbal</li>
</ul></div><h3 class="jobSectionHeader"><b>Preferred Qualifications</b></h3><div>
<ul><li>Experience in claims payment processing or financial operations</li>
<li>Experience with reconciliation and audit processes</li>
<li>Georgia Property &amp; Casualty Adjuster license (or ability to obtain)</li>
<li>Experience working in a high-volume, service-oriented environment</li>
</ul></div><h3 class="jobSectionHeader"><b>This Role Might Be a Great Fit If You&hellip;</b></h3><div>
<ul><li>Enjoy leading teams and improving operational performance</li>
<li>Thrive in environments that require accuracy, urgency, and accountability</li>
<li>Like balancing people leadership with process improvement</li>
<li>Take pride in delivering high-quality, efficient outcomes</li>
</ul></div><h3 class="jobSectionHeader"><b>What We Offer</b></h3><div>
<ul><li>Competitive salary</li>
<li>Comprehensive medical, dental, and vision benefits</li>
<li>401(k) with company match</li>
<li>Paid time off and company holidays</li>
<li>Opportunities for leadership growth and development</li>
<li>A collaborative and performance-driven work environment</li>
</ul></div><div>At APCO, the way we work matters just as much as the results we deliver. Our values guide how we work, how we partner, and how we deliver results.</div>
<div></div>
<div>We C.A.R.E.</div>
<div><b><i>C</i></b><i>ommitted</i> &ndash; We build strong, high-trust relationships with our partners and each other.</div>
<div><b><i>A</i></b><i>ccountable</i> &ndash; We take ownership of outcomes and hold ourselves to the highest standards of performance and integrity.</div>
<div><b><i>R</i></b><i>esults-Driven</i> &ndash; We focus on delivering measurable outcomes that create value for our partners and our business.</div>
<div><b><i>E</i></b><i>xcellent</i> &ndash; We strive for excellence in everything we do while balancing short-term performance with long-term success.</div>
<div></div>
<div>If you're excited about joining a team that values collaboration, accountability, and continuous improvement, we'd love to hear from you.</div><br>
<div></div>
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<div><i>By submitting your application, you acknowledge that you have read and understand our </i><i>Privacy Policy</i><i>. APCO Holdings may collect personal information (such as name, contact details, and employment history) to evaluate your candidacy. We may share this data with our subsidiaries, affiliates, and service providers. We retain applicant data only as long as necessary for the hiring process or as required by law.</i></div>
<p>
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.</p></div>

Manager, Claims Payment Processing

Medlogix

<p></p><div><div><div><div><div><div><b><i>Medlogix, LLC </i></b><i>delivers innovative medical claims solutions through a seamless collaboration of our medlogix&reg; technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients&rsquo; needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers&rsquo; compensation insurance carriers; third party administrators (TPAs); and government entities we serve.</i></div><div></div><div><div><div><br>
Position: <b>Bill Repricer Level II</b></div><div>
Location:<b> </b><b>Remote</b></div><div>
FMLA: <b>Non-</b><b>Exempt, Full-Time</b></div><div>
Schedule: <b>M-F 8am-4:30pm</b></div><div><div><div><div><div><div><b><br>
General Description:</b><br>
<br>
Process Auto Medical and Workers Compensation Bills through various work queues based on jurisdictional and process requirements of Medlogix clients.<br>
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<b>Responsibilities:</b><ul><li>
Process and reprice auto medical claims through different system queues in &ldquo;first in first out&rdquo; order and making sure to keep up with client and regulatory SLAs.<ul><li>
Resolve bill exceptions, verify bill data (bill images against captured data) and resolve discrepancies, follow and apply claims adjuster instructions, review for medical records and flag errors to rejection queue.</li></ul></li><li>
Maintain communication when needed, between yourself and your supervisor</li><li>
Reach a daily average quota with the amount of claims/jobs you process</li><li>
Other job duties as assigned<br>
</li></ul><b>
Qualifications and Experience:</b><br>
<br>
<b>Required</b>:<ul><li>
Excellent written and verbal communication skills</li><li>
Must be process and task oriented</li><li>
Computer savvy and previous experience using Microsoft Office Products</li><li>
1+ years medical coding experience &ndash; CPT, ICD</li><li>
1+ years experience in Medical Bill Repricing</li></ul><p><b><br>
Preferred</b>:</p><br>
<ul><li>
Previous experience in Auto Claim Management</li><li>
Previous experience working in a fast-paced production environment</li></ul><div><b>
EEOC STATEMENT:</b></div><div></div><div><i><br>
Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.</i></div></div></div></div></div></div></div></div></div></div></div></div></div></div><div></div>

Bill Review Repricer - Level II (Remote)

Administrative Concepts, Inc

<p>Are you looking for a career with an established company who values its employees? Administrative Concepts, Inc. (ACI) is a fast-growing company that offers its employees meaningful work and a positive environment. Founded in 1997, ACI is a nationally licensed, full-service, Third-Party Administrator providing enrollment, fulfillment and claims processing services for various insurance lines in the medical claims industry.</p><p><b>GENERAL PURPOSE OF THE JOB:</b> Review and process claims in accordance with training, guidelines, carrier directives, and policy provisions.</p><p><b>ESSENTIAL DUTIES AND RESPONSIBILITIES:</b></p><ul><li>Responsible for reviewing and maintaining a working knowledge of policy and state mandated insurance requirements.</li><li>Responsible to review and process claims for assigned accounts and back up as needed.</li><li>Prepare large claim files for review and send notifications in accordance with best practices for large claims.</li><li>Meet daily/weekly production goals established by management while maintaining processing and financial accuracy standards (95% minimum accuracy required).</li><li>Request refunds, voids, and no-pay adjustments as needed.</li><li>Respond to phone and email inquiries from clients, customers, and business partners (agents, brokers) when needed.</li><li>Provide customer service assistance in responding to benefit and claim questions.</li><li>Respond to questions and specific requests and provide complete information and documentation as needed.</li><li>Responsible to complete special projects.</li><li>Request subrogation and reimbursement letters from appropriate source.</li><li>Review and monitor the suspended claims list to ensure claims are processed within appropriate time limits.</li><li>Complete training rolled out by HR and claim management throughout the year.</li><li>Attend all individual, department and organizational meetings.</li><li>Uphold all company policies, procedures, and HIPAA guidelines</li><li>Adhere to the schedule they have selected, begin work on time.</li><li>Responsible to perform in accordance with all policies and provisions outlined in the ACI handbook.</li><li>Examiners must obtain and maintain individual adjuster licenses within the first twelve months of employment.</li><li>Other claim department duties as assigned by the manager.</li></ul><p><b>DESIRABLE QUALIFICATIONS:</b></p><ul><li>Knowledge of industry and medical terminology and codes</li><li>Understanding of the adjudication process</li><li>Ability to prioritize and organize</li><li>Strong verbal and written communication skills</li><li>Strong data entry skills</li><li>Experience with MS Office</li></ul><p>Pay: $21.00 - $24.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li><li>Work from home</li></ul><p>Work Location: Remote</p>

Medical Claims Examiner (Remote)

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