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Claims Processor

Company: Assured Benefits Administrators, Inc.
Location: Oklahoma City
Posted on: June 6, 2024

Job Description:

Job Description
Job Description
Position Summary
As a Claims Processor, you will play a pivotal role in ensuring the efficiency and accuracy of claims processing within our organization. Your responsibilities will encompass a wide range of tasks, including year-end processing, managing adjustments, coordinating benefits, handling subrogation and high-dollar claims, processing Medicaid claims and complex appeals, and engaging in hospital audits.
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:

  • Year-End Processing: Oversee and facilitate the year-end processing activities to ensure timely and accurate closure of claims records.
  • Adjustments Management: Process adjustments to claims as needed, ensuring proper documentation and adherence to company policies and procedures.
  • Coordination of Benefits: Manage coordination of benefits for claims.
  • Subrogation and High-Dollar Claims: Handle subrogation claims and high-dollar claims, applying sound judgment and attention to detail in reviewing and processing these complex cases.
  • Process refund requests.
  • Medicaid Claims and Complex Appeals: Process Medicaid claims and assist in handling complex appeals, demonstrating a thorough understanding of Medicaid regulations and procedures.
  • OGA Coordination: Manage chats with OGA and provide accurate answers to inquiries related to claims processing, demonstrating strong communication skills and a deep understanding of our processes.
  • Hospital Audits: Conduct hospital audits to ensure compliance with contractual agreements and regulatory requirements.
  • Case Management Reports: Analyze case management reports and make sure they are filed to the correct member.

    Minimum Qualifications (Knowledge, Skills, and Abilities)

    • Bachelor's degree in business administration, healthcare management, or a related field preferred. Equivalent work experience may be considered.
    • Experience: Minimum of 3 years of experience in claims processing or related field.
    • Strong understanding of claims processing procedures, including familiarity with medical terminology and insurance policies
    • Highly detail-oriented with a focus on accuracy and quality assurance in claims processing
    • Strong analytical and problem-solving skills with the ability to identify root causes and develop solutions.
    • Experience in handling escalated issues and making sound decisions under pressure.

      TO ALL RECRUITMENT AGENCIES: The Company and its affiliates do not accept unsolicited agency resumes. Please do not forward resumes for any of our job postings, to our careers sites, or to any employees of the Company or its affiliates. We are not responsible for any fees related to unsolicited resumes.

Keywords: Assured Benefits Administrators, Inc., Oklahoma City , Claims Processor, Other , Oklahoma City, Oklahoma

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