[Hiring] Claims Processor II @CGS Administrators, LLC

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves reviewing and adjudicating complex or specialty claims. The responsibilities include determining whether to return, deny, or pay claims following organizational policies and procedures, as well as assisting in training or mentoring new staff members. • Examines and processes complex or specialty claims according to business/contract regulations, internal standards, and examining guidelines. • Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. • Verifies that claims have been keyed correctly. • Ensures that claims are processing according to established quality and production standards. • Corrects processing errors by reprocessing, adjusting, and/or recouping claims. • Researches and resolves claims edits and deferrals. • Performs research on claim problems by utilizing policies, procedures, reference materials, forms, and coordinates with various internal support areas. • Responds to routine correspondence and completes spreadsheet if applicable. Qualifications • High School Diploma or equivalent • 2 years of experience processing, researching, and adjudicating claims. • Strong organizational, analytical, and judgment skills. • Strong oral and written communication skills. • Proficient in spelling, punctuation, and grammar. • Proficient in basic business math. • Ability to handle confidential or sensitive information with discretion. • Microsoft Office proficiency. Requirements • 2 years of claims processing experience (preferred). • Strong time management skills (preferred). • Knowledge of mathematical and statistical concepts (preferred). • Proficient in word processing and spreadsheet applications (preferred). • Proficient database software skills (preferred). Benefits • Subsidized health plans, dental and vision coverage • 401k retirement savings plan with company match • Life Insurance • Paid Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks, and more Apply tot his job