Job Description

The Claim Processor is responsible for timely processing of medical claims based on the member’s health benefit program. They analyze medical information, perform data entry, handle reimbursement claims, and decide whether a claim should be covered or denied. Communicate issues or exceptions to other concerned departments as necessary.

This role will be hired under Flexicare, Health Delivery System, Inc. (HDSI)—a subsidiary of RelianceUnited for a 4-month fixed-term contract.

Duties and Responsibilities:

• Process claims by reviewing, researching, investigating, and adjudicating claims.
• Authorize the appropriate payment or refer/escalate claims to concerned parties for further review.
• Adjudicate claims, analyze validity, identify trends, and provide reports if necessary.
• Communicate any discrepancy of claims.
• Consistently meets established productivity, schedule adherence, and quality standards. Suggest any process improvement ideas to the team lead that would greatly impact the process.
• Attend any developmental training for career and personal development.

Qualifications:

• Candidates must possess at least a bachelor's/college degree in any field.
• Prior experience in claim reconciliation within the HMO or insurance industry is preferred.
• Ability to do on-site visits and extend beyond company operating hours when needed.
• Good communication and critical thinking skills.
• Knowledgeable of Google platforms such as, but not limited to, GDocs, GSheets, etc., and MS Office.
• Ability to handle multiple tasks in a timely manner on a continual basis under strict deadlines.
• Strong planning, organization, and follow-up skills.
• Proven ability to work independently and as a team member
• Adheres consistently to the company values