Claims Processor II in Boston, MA at Beacon Health Options

Date Posted: 5/9/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Claims Processor II to join our team at our office in Boston, MA!  The Claims Processor II is responsible for data entry, processing, and adjusting all claims submissions, including both inpatient, outpatient, and those with third party liability.

Position Responsibilities:

  • Review all claim types to determine completeness and appropriateness for payment, according to existing policies and procedures.
  • Adjudicate claims to completion whether paid or denied, meeting or exceeding department standards relative to production and accuracy.
  • Perform data entry of paper claims when directed.
  • Review system outputs to ensure correct adjudication. Re-adjudicate or have claims adjusted as necessary.
  • Perform research on pending claims until resolution is reached in order to pay or deny according to policies and procedures.
  • Respond to requests and inquiries from the Customer Service Engagement Center to investigate claims issues per provider calls.
  • Communicate with internal customers as necessary to obtain information.
  • Communicate with external customers when directed to help resolve issues.
  • Complete any projects or additional assignments as directed.

Position Requirements:

  • Education: High School diploma or GED equivalent required
  • Relevant Work Experience:   2 to 3 years of related work experience in a related field is      preferred
  • Knowledge, Skills & Abilities:
    • Familiarity with health care claims and HIPAA regulations helpful.
    • Must be willing to communicate with external customers when necessary (mainly through telephone) to help resolve issues regarding claims.
    • Must meet department standards regarding productivity and accuracy, and be willing to complete any additional projects or assignments as directed from management.

To Apply:

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Beacon Health Options company is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled