What are the responsibilities and job description for the Claims Processor position at KMM Technologies, Inc.?
Position: Claims Processor
Location: Reston, VA #HYBRID
Duration: 5 months Contract
Rate: $22/hr on W2
Job Description
60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
25% Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.
10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.
Thanks & Regards,
--
LAXMAN
Team Lead - Talent Acquisition
KMM Technologies, Inc.
CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified
WOSB, SBA 8(A), MDOT MBE & NMSDC MBE
Contract Vehicles: 8(a) STARS III & Schedule 70
Tel: (240) 800-0039 |Email: lax@kmmtechnologies.com
Location: Reston, VA #HYBRID
Duration: 5 months Contract
Rate: $22/hr on W2
Job Description
- Under direct supervision, reviews and adjudicates paper/electronic claims.
- Determines proper handling and adjudication of claims following organizational policies and procedures.
- Education Level: High School Diploma or GED
- less than one year experience processing claim documents
- 1-3 years Claims processing, billing, or medical terminology experience
- Required Skills: Claims processing on the FACETS G6 platform, Guiding Care, SIR, TI Portal
- Demonstrated analytical skills, Proficient
- Demonstrated reading comprehension and ability to follow directions provided, Proficient Basic written/oral communication skills , Proficient
- Demonstrated ability to navigate computer applications , Proficient
60% Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
25% Completes research of procedures. Applies training materials, correspondence and medical policies to ensure claims are processed accurately. Partners with Quality team for clarity on procedures and/or difficult claims and receives coaching from leadership. Required participation in ongoing developmental training to performing daily functions.
10% Completes productivity daily data that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design and financial planning, etc.
5% Collaborates with multiple departments providing feedback and resolving issues and answering basic processing questions.
Thanks & Regards,
--
LAXMAN
Team Lead - Talent Acquisition
KMM Technologies, Inc.
CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified
WOSB, SBA 8(A), MDOT MBE & NMSDC MBE
Contract Vehicles: 8(a) STARS III & Schedule 70
Tel: (240) 800-0039 |Email: lax@kmmtechnologies.com
Salary : $22
