What are the responsibilities and job description for the Medical Claims Processor position at Diverse Lynx?
Title: Claims Processor
Profession: Finance/Accounting
Location: West Valley City, UT 84120
Duration: 13 Weeks
Shift: Day 5x8-Hour (08:00 - 17:00)
Description:
Work Environment
Training: Onsite at 4255 Lake Park Blvd, West Valley City, UT 84120
Ongoing Work: Remote, with one required onsite day per month
Schedule: Day shift, Non-Exempt
Job Description: Claims & Benefits Resolution Specialist
Location: West Valley City, UT (Training Onsite; Remote After Training with 1 Required Onsite Day/Month)
Department: Revenue Cycle Management – Central Business Office
Assignment Length: 3 Months (Potential Extension)
Position Summary
This role performs comprehensive audits and resolution activities across the claims lifecycle, ensuring accurate billing, timely reimbursement, and compliance with payer requirements. The specialist will handle complex claim discrepancies, conduct follow-up with payers, and coordinate with clinical and non-clinical teams to finalize claim determinations. The ideal candidate has strong revenue cycle experience, particularly in claims, eligibility, benefits, and authorizations, and can quickly identify root-cause errors in a high-volume environment.
This is an operational “fix-it” position — the manager needs someone who doesn’t just process claims but can find what’s broken and correct it without hand-holding.
Key Responsibilities
Claims Audit & Correction
Perform comprehensive audits on assigned accounts to identify billing, payment, and adjustment errors.
Correct claim discrepancies within established turnaround times.
Ensure claim data accuracy, compliant coding, and alignment with the member’s plan benefit.
Timely & Accurate Claims Processing
Process claims quickly and accurately according to organizational benchmarks.
Apply reimbursement rules based on the member’s benefits and plan specifications.
Validate supporting documentation needed for accurate processing (eligibility, benefits, authorizations, etc.).
Complex Follow-Up & Dispute Resolution
Conduct follow-up on delayed, denied, or pended claims; escalate unresolved items as needed.
Investigate processing delays, missing information, or system errors and implement corrective action.
Refer cases to clinical management teams when medical review is required to ensure appropriate reimbursement.
Eligibility, Benefits & Authorization Coordination
Verify and document member eligibility, benefits coverage, and authorization requirements.
Identify discrepancies in coverage or authorizations that impact payment determinations.
Communicate directly with payers or internal departments to resolve missing or inconsistent benefit information.
Required Skills & Experience
Minimum 2–3 years of experience in healthcare revenue cycle, claims processing, eligibility/benefits, or authorizations.
Strong understanding of payer rules, reimbursement methodologies, and claims adjudication.
Familiarity with Epic, payer portals, and other claims/RCM systems.
High accuracy in auditing and error resolution work.
Experience resolving complex claim issues across multiple systems.
Ability to work independently, troubleshoot problems, and drive claims to completion.
Strong communication skills for interacting with payers, internal teams, and leadership.
Comfortable with onsite onboarding and required monthly onsite days.
Preferred Qualifications
Experience working in a Central Business Office or Shared Services model.
Prior experience supporting Utah-based payer populations or multi-state payer networks.