CLAIMS PROCESSOR JOB DESCRIPTION

Adjudicating a health plan claim means reading a CMS-1500 or UB-04 form against a member's benefit summary, then making a coverage determination that directly affects what a patient owes. Claims Processors in health insurance operate within HIPAA-governed workflows and must understand medical coding systems, including ICD-10, CPT, and HCPCS. The role sits within a claims department that tracks financial accuracy and production volume as primary performance measures. Few functions in a health plan are as close to the member's actual care experience.

As the Claims Processor, you will adjudicate fully-insured and government-program health plan claims within defined quality and productivity standards, applying benefit provisions, provider contract terms, and medical coding logic to determine accurate payment or denial. Your work spans routine and moderately complex claim types and is accountable to departmental accuracy targets, with escalation pathways to senior processors or supervisors for high-complexity cases.

• Career Impact: Hands-on experience adjudicating Medicaid, Medicare, and commercial claims builds the coding and regulatory fluency that supports a Certified Professional Coder credential and advances your standing in health plan operations.
• Business Impact: Each determination you make affects a member's out-of-pocket liability and a provider's reimbursement timeline, making accuracy in this seat a direct measure of plan integrity.
• Growth Opportunity: The production and quality metrics tracked in this role create a documented performance record that opens pathways to Claims Examiner, Claims Analyst, and medical billing and coding specialist roles.

• Adjudicate routine and moderately complex health plan claims against benefit summaries, provider contract terms, and departmental processing guidelines.
• Review member eligibility, coordination of benefits information, and cost-share application to arrive at accurate payment determinations.
• Analyze ICD-10, CPT, HCPCS, and revenue codes to resolve claim edits, warning messages, and error codes within the adjudication system.
• Validate CMS-1500 and UB-04 form fields for completeness and flag claims with inaccurate or missing data for appropriate routing.
• Monitor individual production and financial accuracy against established departmental standards, meeting or exceeding the target threshold.
• Escalate high-cost, complex, or questionable claim activity to senior processors or supervisors with documented rationale.
• Collaborate with claims staff and department leadership to continuously improve workflows and sustain compliance with regulatory requirements.

• Bachelor's degree in health administration, business, or a related field, or equivalent work experience.
• 1 or more years of medical claims processing experience, with demonstrated ability to meet production and quality standards.
• Working knowledge of ICD-10, CPT, HCPCS, DRG, and revenue coding systems used in health plan adjudication.
• Familiarity with CMS-1500 and UB-04 claim forms and the data fields required for correct processing.
• Understanding of HIPAA protocols, EDI transactions, and health plan compliance requirements.
• Strong analytical and detail-oriented approach, with the ability to identify discrepancies and resolve claim edits accurately.
• Effective verbal and written communication skills for interacting with clinical, administrative, and vendor contacts.

• Certified Professional Coder (CPC) credential or active progress toward certification.
• Experience processing Medicaid or Medicare program claims, including familiarity with Medi-Cal or similar state program guidelines.
• Prior work within a third-party administrator, managed care organization, or health and welfare benefits environment.
• Medical billing and coding background as a supplement to or substitute for direct claims processing experience.

• Financial accuracy rate, measured against a departmental threshold (typically 97% or higher) for payment determinations.
• Claim production volume per day or week, tracked against individual and departmental output standards.
• Claim edit resolution rate, reflecting how completely coding and eligibility errors are cleared without supervisor escalation.
• Turnaround time per claim type, measuring adherence to internal processing timelines and service commitments.
• Escalation ratio, tracking the proportion of complex or flagged claims appropriately elevated versus handled at incorrect level.
• Typical tools: Claims adjudication platforms (commonly Facets or HealthSuite); medical coding reference systems (commonly encoder software).

• Base Salary Range: $38,000 to $52,000 annually, depending on experience and coding credentials
• Bonus: Discretionary annual bonus, typically 3% to 5% of base salary
• Equity: Not typical at this level in health insurance operations
• Health Benefits: Medical, dental, and vision coverage; often subsidized for employee and dependents
• PTO: 10 to 15 days annually, plus standard federal holidays
• Common Perks: Tuition reimbursement for coding certifications, remote or hybrid scheduling in some plans

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by applicable federal, state, or local law. Candidates requiring reasonable accommodations during the application or hiring process are encouraged to make that need known. Employment in this role is contingent on satisfactory completion of a background check, which may include review of criminal history and, where applicable, drug screening. All applicants must be authorized to work in the United States.

The Claims Processor owns adjudication of consumer-driven health plan claims, including FSA, HSA, and HRA accounts, applying plan-specific policy provisions to determine liability, approve or deny submissions, and negotiate settlements. Working alongside client service representatives and reporting to team management, the Claims Processor delivers accurate, compliant outcomes that protect client relationships and meet the company's service standards.

Key Responsibilities

• Apply general processing procedures and specific guidelines to correctly process claims.
• Review and interpret pending claims to determine the appropriateness of the claim status and take necessary actions within FSA policy provisions.
• Examine information including authorizations, payments, and denials, and resolve outstanding issues to meet client expectations.
• Partner with client service representatives to correct errors, rectify omissions, and investigate questionable issues.
• Explain rationale for claim adjustments to appropriate internal and external parties, including payments and denial decisions.
• Adhere to internal and external compliance and security processes.
• Report daily production to senior claims processors and team management.
• Assist with special projects as determined by team management.

Required Qualifications

• High school diploma or GED required, Bachelor's degree preferred.
• Minimum of 1 year of demonstrated claims processing experience.
• Experience with consumer spending health plans, including flexible spending accounts, health reimbursement accounts, and health savings accounts, required.
• Experience within a third-party administration, benefits brokerage, health and welfare consulting, healthcare, or insurance-related industry highly preferred.
• FSA and HSA knowledge or experience required.
• Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, Outlook, and Access.
• Strong organizational and analytical skills with close attention to detail.
• Excellent troubleshooting, decision-making, and problem-solving skills.
• Solid interpersonal, verbal, and written communication skills.
• Demonstrated ability to provide superior customer service and maintain positive relationships with client contacts.
• Able to multitask, prioritize projects, and meet deadlines in a fast-paced environment.
• Aptitude for learning internal systems, applications, and departmental workflows.

Embedded within a global insurance operation, the Claims Processor delivers investigation, analysis, resolution, trending, and corrective action across all claims and complaints to increase recovery and ensure timely filing. Working closely with service providers and cross-functional teams, the Claims Processor supports effective claim management and contributes to the organization's continued growth through accurate, responsive processing.

Core Functions

• Investigate, analyze, resolve, trend, and take corrective action on all claims and complaints.
• Ensure claims are filed on time and implement claim processing procedures to increase recovery.
• Implement claim processes globally.
• Liaise with service providers and operate cross-functionally to support the effective management of claims.
• Assist in the review of claims where appropriate.
• Identify and respond to requests for support from the wider group.

Qualifications & Experience

• Bachelor's degree required.
• Minimum of 1 year of experience in complaint investigation.
• Proficiency in Microsoft Office applications, including Word, Excel, and Outlook.
• Solid verbal and written communication skills.
• Ability to proactively self-manage a high-volume caseload in a fast-paced environment.

Reporting to management, the Claims Processor shapes the full claims documentation process, from recording and investigating submissions to balancing monthly reports and coordinating salvage disposals. Partnering with management on open and pending claim analysis, the Claims Processor contributes to accurate financial reconciliation and timely recovery across logistics and contract-based claims activity.

Primary Duties

• Record, investigate, and collect claims documentation.
• File and recover assigned claims.
• Balance monthly claims reports.
• Prepare claim data reports as needed by management.
• Coordinate salvage sale of rejected product in coordination with and guidance from management.
• Report and analyze open and pending claims with management.

Skills & Qualifications

• Bachelor's degree preferred.
• 2 to 5 years of claims management experience preferred.
• Basic understanding of contracts and certificates of insurance.
• Basic knowledge of accounting, logistics, documentation, and receivables and payables.
• Intermediate to advanced knowledge of Microsoft Office, including Word and Excel.
• Strong attention to detail, sense of urgency, and excellent problem-solving skills.
• Self-motivated, organized, customer-focused, with strong negotiation techniques.
• Excellent communicator with the ability to multitask and prioritize.

Sitting at the intersection of claims intake and risk management, the Claims Processor leads new claim entry across email, phone, and mail channels into the claims management system while coordinating referrals to the third-party claims administrator. Operating across customer-facing and administrative functions and supporting the Sr. Director of Risk Management, the Claims Processor ensures accurate, timely intake that enables effective downstream claim handling.

Duties

• Receive new claims via email, phone, or mail and enter the claim into the claims management system.
• Conduct follow-up for additional information needed for claim input.
• Retrieve calls from the claims hotline.
• Report claims to the third-party claims administrator for handling as necessary.
• Perform other administrative duties as assigned.
• Convey a positive attitude and team spirit for optimum provision of services to customers.

Experience & Qualifications

• High school diploma and 3 years of work experience.
• Strong organizational skills with demonstrated ability to work independently and manage multiple tasks simultaneously.
• Excellent verbal and written communication skills and strong customer service skills.
• Attention to detail.
• Computer literacy, including MS Office, Word, Excel, and Outlook.

A key member of the Third Party Administrative unit, the Claims Processor builds accurate records and payment documentation across Workers' Compensation and Personal Injury Protection claims while providing broad clerical support, including mail distribution, batch billing, and audit recordkeeping. Collaborating across client systems, vendor contacts, and department management, the Claims Processor enables compliant, audit-ready processing that meets departmental reporting and regulatory standards.

Accountabilities

• Process claim closures, supplemental payments, and Workers' Compensation and Personal Injury Protection documents.
• Provide clerical support for the Third Party Administrative unit, including researching, reviewing, and distributing mail, invoices, and incoming faxes, handling vendor inquiries, and maintaining Excel reports.
• Research, verify, edit, and reconcile documents and discrepancies as requested.
• Maintain records of files in offsite storage and records of Disability Compensation Division hearings and decisions.
• Maintain and provide reports on hearings and training to department management.
• Assist with batch billings for payment, enter payments in various software systems, upload documents to client systems, and maintain records for audit purposes.
• Assist with processing customer survey responses, recording and distributing responses to the unit.
• Support occasional special projects as assigned.

Background & Experience

• High school diploma or equivalent.
• 2 years of general office experience.
• Insurance-related experience, including knowledge of Workers' Compensation forms and ACORD forms, preferred.
• Basic proficiency in Microsoft Office, including Word, Excel, and Outlook.
• Typing speed of 35 or more words per minute and 10-key by touch.
• Excellent verbal and written communication skills.

The Claims Processor delivers claims support and eligibility review across a multi-geography vehicle-sharing marketplace, handling customer inquiries, collections assessment, and workflow documentation for both internal and external stakeholders. The work directly supports platform integrity and member experience by streamlining self-resolution processes and maintaining quality standards across an evolving operational environment.

Functions

• Provide claims support to internal and external customers.
• Provide exceptional customer service to customers, external vendors, and claims associates.
• Support collections efforts and review eligibility for accounts and vehicles relative to claims.
• Assist customers in the self-resolution process.
• Contribute to internal process documents and help streamline workflows.

Position Requirements

• Associate's degree with 2 or more years of work experience, or Bachelor's degree or equivalent preferred.
• Prior startup experience strongly preferred.
• Ability to work in an evolving environment while maintaining quality standards, meeting KPIs, and requiring minimal supervision.
• Strong proficiency with technology, including CRM systems and claims management platforms.
• Strong attention to detail, positive attitude, high energy, and strong work ethic.
• Thrives in ambiguous environments and is comfortable with situations that are not always clearly defined.

As the Claims Processor, this role owns data entry, benefit eligibility determination, and payment verification for incoming claims, applying pre-defined methods and guidelines to resolve edits and maintain accurate records. The claims department relies on this work to sustain production and quality standards and ensure issues are escalated to supervision at the appropriate threshold.

What You'll Do

• Determine if claim information is complete and correct.
• Enter and verify claims data.
• Resolve claim edits, review history records, and determine benefit eligibility for service.
• Review payment levels to arrive at a final payment determination.
• Meet all production and quality standards.
• Attend all required training classes.
• Elevate issues to the next level of supervision as appropriate.
• Maintain accurate records, including timekeeping records.

Knowledge, Skills & Abilities

• Knowledge of administrative and clerical procedures, including word processing and managing files and records.
• Knowledge of operating systems specific to claim processing.
• Ability to take direction and navigate through multiple systems simultaneously.
• Ability to use mathematics to adjudicate claims.
• Ability to solve problems within pre-defined methods and guidelines.

Claims Processor handles standard and complex insurance claims from assessment through resolution, preparing approval and rejection correspondence, processing stop payments and system adjustments, and supporting insurer audits alongside the senior team. The work directly supports the company's cost containment objectives and service standards, requiring bilingual proficiency in English and French and applied knowledge of medical and dental claim requirements.

Job Functions

• Assess and process standard and complex claims in accordance with the company's service standards, procedures, and insurance policy guidelines.
• Analyze estimates and prepare approval and rejection letters.
• Assist the senior team in handling complicated cases, complaint cases, and insurer audits.
• Process stop payments, system adjustments, reissued cheques, and cancellation cheques for claims.
• Obtain additional information needed to assess a claim through the provider or the subscriber.
• Assist in the identification and actualization of cost containment opportunities.
• Manage cases and handle claim inquiries ranging from basic to complex.
• Support other business initiatives and projects as assigned.

Professional Experience

• Medical and dental knowledge and experience.
• Good analytical, judgment, and comprehension skills.
• Accuracy-driven and detail-oriented with strong problem-solving and decision-making skills.
• Able to work under pressure, independently, and as part of a team.
• Excellent customer service skills and professionalism.
• Bilingual in English and French, spoken and written, a very strong asset.

The Medical Claims Processor produces accurate pay or deny determinations by reviewing benefit summaries, membership eligibility, coordination of benefits data, and error codes in accordance with HIPAA guidelines. Reporting within a production-based claims environment and supporting Medicaid, Medicare, and commercial plan members, the Medical Claims Processor enables correct cost-share application and provider assignment that directly affects member financial liability.

Day-to-Day Responsibilities

• Pay or deny claims according to the benefit summary.
• Review membership eligibility for determination.
• Assign the correct provider for proper payment.
• Follow all HIPAA guidelines.
• Review member out-of-pocket costs for correct cost-share application.
• Review coordination of benefits information and apply it accordingly.
• Review error codes, warning messages, and edits for correct processing.
• Analyze claims for correct payment verification and adjust where needed.

Education & Experience

• High school diploma or GED.
• Knowledge of Medicaid, Medicare, or commercial claims processing.
• Coordination of benefits and benefit summary knowledge.
• Experience with claims or customer service in the medical field.
• Basic MS Excel skills.
• Ability to work independently and with others in a fast-paced, production-based environment.

Reporting to a supervisor within an international insurance operation, the Claims Processor refines adjudication of medical, dental, and vision claims across global policy terms, monitoring high-cost submissions and turnaround times to meet personal and team productivity goals. Partnering with internal and external customers across European business lines, the Claims Processor advances first-contact resolution and process improvement in a multilingual, cross-border claims environment.

Role Responsibilities

• Adjudicate international medical, dental, and vision claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• Monitor and highlight high-cost claims and ensure relevant parties are informed.
• Monitor turnaround times to ensure claims are settled within required timeframes and highlight issues to the supervisor when timelines are at risk.
• Respond within committed timeframes to inquiries regarding plan design, eligibility, and claims status, and perform necessary action with first-contact resolution where possible.
• Interface effectively with internal and external customers to resolve issues.
• Identify potential process improvements and make recommendations.
• Actively support other team members to enable all team goals to be achieved.
• Carry out other tasks as required to meet business needs.

Minimum Qualifications

• Related working experience required.
• Fluent English required; proficiency in one or more additional languages, including Chinese, Dutch, Hebrew, Japanese, Korean, German, Russian, Arabic, Polish, or French, is an asset.
• Proficiency in Microsoft Office applications.
• Strong interpersonal skills with excellent attention to detail, accuracy, and verbal and written communication.
• Strong customer focus with ability to identify and solve problems independently and proactively recommend process improvements.
• Ability to meet and exceed targets while managing multiple priorities.

Embedded within a health plan claims department, the Claims Processor oversees accurate review, entry, and processing of all submitted claims, evaluating system error screens, routing submissions to appropriate queues, and manually pricing claims against departmental guidelines. Working closely with supervisors, management, and claims staff, the Claims Processor sustains compliance with regulatory requirements and consistently meets production and financial accuracy metrics.

Scope of Work

• Research claims for completion and appropriateness.
• Review and handle rejected claims as necessary.
• Evaluate claims management system error screens and base payment determinations using departmental processing guidelines.
• Utilize claims department policies, procedures, workflows, and manuals to meet production and quality metrics.
• Review routine and moderately complex claims and edits to determine appropriate handling, including paying, denying, or suspending for senior review.
• Manually price claims as needed.
• Communicate identified issues with claims and claims processes to supervisors or management.
• Collaborate with the department to continuously improve workflows and sustain compliance with regulatory requirements.
• Route claims to appropriate queues for resolution and perform other duties as assigned.

Education & Experience

• High school diploma or equivalent required.
• 1 to 2 years of experience as a medical claims processor, meeting or exceeding production and quality standards.
• Knowledge of CPT, HCPCS, ICD-10, and revenue codes.
• Knowledge of CMS-1500 and UB-04 forms and fields.
• Experience processing Medi-Cal or Medicaid program claims preferred.
• Proficiency in Microsoft Office, including Outlook, Word, and Excel.
• Ability to work cooperatively with others and communicate effectively, both verbally and in writing.
• Able to handle multiple projects simultaneously and balance priorities.

A key member of the claims and operations team, the Claims Processor leads vehicle damage assessment by analyzing photos, member feedback, and estimates as a subject matter expert while identifying trends and recommending policy improvements to reduce overall risk profiles. Collaborating across data, operations, and member services teams, the Claims Processor guides members through the damage claim process and delivers solutions that measurably reduce member contact and improve satisfaction.

Work Activities

• Analyze vehicle damage photos, member feedback, and damage estimates as a subject matter expert.
• Work with the data team to analyze trends and provide actionable feedback to reduce overall risk profiles and claims activity.
• Recommend improvements to policies and procedures to optimize workflow and train and support internal and external teams on relevant tools and procedures.
• Monitor member behavior to identify bad actors or areas requiring education and propose solutions.
• Guide members involved in accidents through the damage claim process and explain next steps.
• Identify proactive measures to reduce member contact and improve member satisfaction.
• Respond to member inquiries and escalated operational failures in a timely fashion.
• Collaborate with operations and member services teams to identify solutions that reduce member impact.
• Assist with special projects including invoice audits, data collection, and financial reviews.

Required Qualifications

• Bachelor's degree preferred, or 2 years of relevant experience in insurance, transportation, or logistics.
• Knowledge of Microsoft Office applications required.
• Comfort working across multiple proprietary software systems.
• Excellent interpersonal, influencing, and process skills.
• Able to communicate effectively at all levels and articulate ideas, results, and recommendations.
• Able to prioritize work independently, ensuring accuracy while meeting deadlines in a fast-paced environment.

Sitting at the intersection of mortgage servicing and insurer compliance, the Claims Processor manages post-foreclosure functions including eviction coordination, property maintenance oversight, title conveyance, and timely filing of MI, investor, and insurer claims with full supporting documentation. Operating under the direction of a department supervisor and adhering to GSE servicing requirements throughout the REO process, the Claims Processor delivers accurate reconciliation and posting of claim proceeds against key performance metrics.

Operational Focus

• Perform post-foreclosure servicing functions as required by mortgage insurer, investor, insurer, and internal guidelines, including eviction management, property inspection and maintenance, conveyance of title, title delivery, and maintenance of HOA, taxes, and property insurance during the REO process.
• File claims for reimbursement of expenses.
• Reconcile claim proceeds.
• File supplemental claims as needed.
• Ensure data accuracy.
• Achieve key metrics associated with the process.

Experience & Qualifications

• Default-related experience preferred.
• Familiarity with GSE and insurer servicing guidelines.
• Financial services and mortgage industry experience preferred.
• Demonstrated aptitude for data, reporting, and working with numbers.
• Proficiency in MS Excel and Word required.
• Excellent critical thinking, problem-solving, and mathematical skills with sound judgment.
• Strong attention to detail with the ability to work independently and as part of a team.
• Strong business acumen with the ability to interface with executive management.

As the Claims Processor, this role builds and maintains the end-to-end payment infrastructure for new and continuing claims, setting up coverage determinations, creating system payments, balancing carrier transaction reports, and testing ACH account configurations. The claims and examiner teams rely on this work to ensure accurate disbursement, complete documentation, and trained processor capacity as the operation grows.

Key Deliverables

• Receive new and continuing claims, determine coverage, set up claims in the system, and prepare and disburse claim files to examiners.
• Create claim payments in the system, enter claim notes, maintain carrier transaction reports, and balance reports for each carrier to ensure accuracy of payments.
• Take incoming phone calls to assist claimants, financial institutions, and carriers, and document interactions within claim files and the claims system.
• Request missing information to establish new claims from claimants and financial institutions.
• Create new template letters and update existing ones.
• Test new account setups for ACH claim payment processing and updates to live system environments.
• Train new processors as needed.

Background & Experience

• High school diploma or equivalent.
• At least 2 years of analytical general office or related experience.
• Some college coursework in medical terminology or a related field preferred.
• Working knowledge of Microsoft Word and Excel.
• Strong analytical, organizational, and detail-oriented skills.
• Excellent verbal and written communication skills.
• Typing speed of 40 or more words per minute and 10-key by touch.
• Able to perform physical filing duties, including lifting to 20 lbs of files and documents.

Claims Processor executes end-to-end warranty claim adjudication, from preparing repair orders and verifying administrative data to coordinating authorization with customers and service dealers and tracking returned or rejected claims through final resolution. Success in the position means maintaining KPI compliance, serving as inbound contact center backup, and delivering timely, professional communication that promotes customer satisfaction across extended warranty products and services.

Performance Expectations

• Prepare warranty repair orders that are accurate and in compliance with extended warranty policies and procedures.
• Determine and enter the applicable required administrative data on the repair order.
• Check each repair order against history to avoid processing duplicate claims or repeat repair comebacks.
• Work with the customer and service dealer on repairs to be performed, authorization requirements, and travel and repair reimbursements.
• Contact appropriate parties regarding claims requiring additional authorization or special assistance.
• Communicate adjustments as they occur to the service dealer and department management during the claim process.
• Review and process all returned, rejected, or adjusted extended warranty claims and track each to final resolution.
• Adhere to KPIs as defined by the leadership team to ensure departmental expectations and quality assurance are within standards.
• Act as backup to the inbound contact center team for general customer service on extended warranty plans, claims, credits, sales, and product registration.

Technical Qualifications

• High school diploma required.
• 1 to 3 years of experience as a claims adjuster or in a related role.
• Customer service experience.
• Workers' Compensation experience preferred.
• Office and administrative experience required, including basic knowledge of office procedures.
• Proficiency in Microsoft Office, including Excel, Word, PowerPoint, and Google Docs.
• Strong administrative, organizational, and time management skills with the ability to handle high-volume work under pressure.
• Excellent verbal and written communication skills with a professional, positive, and energetic manner.
• Self-motivated, reliable, and able to work independently and collaboratively at all levels of management.
• Detail-oriented with strong critical thinking, decision-making, and problem-solving skills.

The Claims Processor owns review and adjudication of fully-insured plan member claims, applying CPT, ICD-10, and HCPCS coding logic alongside benefit plan provisions and physician contract pricing to determine accurate payment criteria within defined dollar limits. Reporting to claims department leadership and supporting team members on assigned projects, the Claims Processor delivers compliant, quality-controlled outcomes that directly affect plan member coverage determinations and provider reimbursement accuracy.

Areas of Ownership

• Review and adjudicate claims up to specified dollar limits within performance guidelines, including quality and timeliness.
• Understand and apply company benefit plans and provider contracts when examining and interpreting claim documents.
• Respond to claim-specific questions and partner with leadership on questionable claim activity.
• Apply standard medical coding logic, including CPT, ICD-10, and HCPCS, to determine accurate payment criteria and clear pending claims.
• Research claim edits to determine appropriate benefit application and apply physician contract pricing as needed.
• Identify claims with inaccurate data and route them for review by appropriate team members.
• Support other claims department team members on assigned projects and comply with all departmental and company policies and procedures.

Minimum Qualifications

• High school diploma or GED required; Associate's or Bachelor's degree preferred.
• Certified Professional Coder (CPC) certification preferred.
• Minimum of 1 year of claims processing experience, or equivalent experience in medical billing and coding.
• Knowledge of ICD-10, CPT4, DRG, HCPCS codes, medical terminology, EDI, and HIPAA protocols preferred.
• Proficiency in Microsoft Word and Excel.
• Reliable, accountable, and able to maintain confidentiality, meet deadlines, and manage workload efficiently.
• Strong organizational, communication, and planning skills with the ability to work effectively as part of a team.