Claims Processor (Healthcare)

Minnetonka, MN

Are you efficient, nimble, and detailed? Would your previous supervisors describe you as reliable and a team player? Do you have healthcare claims and project/processing experience? We want to speak with you!

Humera is seeking 10+ healthcare Claims Processors to join our client's prestigious Claims team. In this role, you will be responsible for the efficient and accurate processing of medical professional, institutional, dental, vision, and pharmacy claims. The person in this position will be processing approximately 30+ claims per day. There are multiple opportunities available for a training class starting on May 24th.

This is a Contract to Hire opportunity. Though starting remote, only local candidates will be considered, as these positions will eventually return on site in the Twin Cities area.

Duties

Claims Processing 70%

  • Review claims to ensure proper information is on the claim to complete processing
  • Request documentation to finalize claim
  • Identify contract specific situations and manually calculate contract benefits using pricing and out-of-pocket procedures
  • Process claims in adherence with policies, procedures, and other applicable rules as well as claims quality and production standards
Claims Examination 10%
  • Examine all types of medical, dental and vision claims in accordance with established contractual agreements and benefit plan design
  • Enter claims data information into the claims processing system
  • Review and Repair electronic claims and process adjustments
Claims Investigation 10%
  • Research and resolve advanced system edits
  • Evaluate and research non-routine claims for processing such as coordination of benefits, medical necessity, and other coverage benefits and resolve system edits
  • Research, investigate, and follow up on necessary benefit policies as indicated in the Certificate of Coverage or Summary Plan Document
  • Research and process or adjust high dollar claims.
Claims Efficiency 10%
  • Ensure timely and accurate payment or denial of claims or adjustments
  • Perform audits on peers and auto adjudicated claims on a regular basis
Claims Clerical Documentation <5%
  • Document any additional information or specific action taken using the proper system

Requirements

EDUCATION/EXPERIENCE

  • High School Degree or equivalent with two years or more post-secondary preferred
  • 2 years of experience in a healthcare related setting ; 1 year of IFB related experience (Enrollment/Contact Center/Billing/Finance) preferred
  • Prior healthcare related experience in a payer or medical office/facility environment
  • Demonstrated flexibility to adapt to changes in procedures and job assignments
  • Ability to work independently and seek solutions to problems
  • Prioritization skills in order to schedule work to meet deadlines
  • Well-developed analytical skills to evaluate and determine the appropriate course of action
  • Strong digital computing skills including ability to work in multiple systems and with dual screens.
  • Good reading skills required for following claims procedures
  • Demonstrated ability to analyze detailed information, issues, situations, and procedures to develop effective solutions.
  • Ability to work independently and seek solutions to problems
  • Ability to identify trends and ask good questions to improve processes
  • Ability to follow detailed instructions and make independent decisions
SKILLS/ABILITIES
  • Written and verbal communications
  • Positive and respectful
  • High ethical standards
  • Self-motivated
  • Possess personal integrity
  • Able to collaborate with a team
  • Sound technical skills, expert analytical ability, and good judgment

Schedule

Training

  • 6 weeks of training; mandatory attendance
  • Training hours 8:00AM - 4:30PM
  • Training class starts May 24th, 2021
Regular Hours of Operation:
  • 8:00AM – 5:00PM
  • Working hours are flexible. Contractors are able to start as early at 6:30am and as late as 9:00am, and then put in their 8 hours.

Post Date: 05.06.2021

Salary: Dependent on Qualifications

Shift: 1st

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If you would prefer to speak directly to a Humera Staffing Consultant, please call us at 612-977-1440 and reference OrderID 816491


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For more than 45 years you may have known us as Dolphin Staffing - a name synonymous with quality temporary, and direct hire employment in the Minnesota. Today we are Humera - a boutique staffing agency that specializes in the placement of the best and brightest administrative and professional talent for contract, contract to hire and direct hire opportunities. Although we have changed our name, we continue to provide flexible career opportunities across a broad range of industries and with companies large and small. We invite you to become part of our elite workforce today!

Humera Administrative and Professional Staffing is an Equal Opportunity Employer.