Claims Processor -w2 only

Terms of Employment

• W2 Contract, 5 Months

• Candidates must reside in the Eastern or Central Time Zone.

Overview

Work with a leading healthcare organization's Federal Employee Program (FEP) Claims Department to make a direct impact on their operations. Due to a recent platform upgrade and an expansion of services, the claims team is facing a significant inventory backlog. We are seeking multiple detail-oriented and adaptable Claims Processors to join this team and help them drive down the inventory and ensure timely processing. This is a vital role where your contributions will be immediately felt. The team prides itself on being collaborative and supportive, even in a remote setting. You will…

• Process a high volume of HMO and PPO claims within the Facets system.

• Adapt to daily shifting priorities, processing various claim types including Medicare claims, paper claims, and subscriber-submitted claims.

• Utilize multiple applications daily to research and process claims, including Transaction Insight (TI Portal) for electronic claims and the Stored Information Retrieval (SIR) system for paper claims.

• Search for member authorizations using the Guiding Care database.

• Analyze claim data and interpret medical terminology from supporting documentation provided by clinical staff.

• Use Microsoft Excel spreadsheets to receive and manage claim inventories.

Required Qualifications

• High School Diploma or GED

• 1-3 years Claims processing, billing, or medical terminology experience.

• Hands-on experience processing claims directly within the Facets platform (legacy or G6).

• Demonstrated experience with the following systems:

o TI Portal (Transaction Insight)

o SIR (Stored Information Retrieval System)

o HealthEdge Guiding Care

o SharePoint

• A strong understanding of medical terminology.

• Proficiency with Microsoft Office, including Excel and Word.

• Excellent analytical skills and the ability to multitask in a fast-paced environment.