Claims Processor

Position: Claims Processor

Location: Reston VA #HYBRID

Duration: 5 months Contract

Rate: $22/hr on W2

Job Description :

• Under direct supervision reviews and adjudicates paper/electronic claims.
• Determines proper handling and adjudication of claims following organizational policies and procedures.
• Education Level: High School Diploma or GED
• less than one year experience processing claim documents
• 1-3 years Claims processing billing or medical terminology experience
• Required Skills: Claims processing on the FACETS G6 platform Guiding Care SIR TI Portal
• Demonstrated analytical skills Proficient
• Demonstrated reading comprehension and ability to follow directions provided Proficient
  Basic written/oral communication skills Proficient
• Demonstrated ability to navigate computer applications Proficient

ESSENTIAL FUNCTIONS :

60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy contracts policies and procedures allowing timely considerations to be generated using multiple systems.

25% Completes research of procedures. Applies training materials correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.

10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling quality improvement initiatives workflow design and financial planning etc.

5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.

Thanks & Regards
--

LAXMAN
Team Lead - Talent Acquisition

KMM Technologies Inc.
CMMI Level 2 ISO 9001 ISO 20000 ISO 27000 Certified
WOSB SBA 8(A) MDOT MBE & NMSDC MBE
Contract Vehicles: 8(a) STARS III & Schedule 70
Tel: Email: