Claims Processor at Diverse Lynx

Job Title: Claims Processor (Non-Voice / Back Office)

Work Location: Tampa FL (Remote)

Type: Fulltime

Qualification

• High School Graduate

Experience

• Minimum 5 years of experience in Claims Processing
• Minimum 3 years of hands-on experience with:
• Medicare & Medicaid claims
• Adjustments and Disputes (Appeals)
• Medical Coding
• UB04 & CMS1500 forms
• Problem-solving claims calculations (Benefit / Out-of-Pocket)

Candidate Specification

• Comfortable working from office
• Typing speed of 25 WPM with 90% accuracy

Process Details

• 5-day working schedule
• Good typing speed required

Please Note

• Candidates must be available onsite in the Tampa office for the first 8 weeks for training.
• After successful completion of training, the role transitions to remote (work from home).
• Ensure candidates meet the minimum 3 years of claims processing experience with the required skill areas mentioned above.

Principal Responsibilities

• Medical Claims Processing: Accurately review, verify, and process insurance claims following company policies and SOPs.
• Documentation Review: Analyze claim documents, medical records, and benefit summaries to determine eligibility and process claims accordingly.
• Customer and Internal Business Partner Interaction: Communicate with members, healthcare providers, and internal teams to resolve claims or gather additional information.
• Data Entry: Enter claim details and maintain accurate records in the claims management system.
• Continuous Improvement: Identify and implement process improvements to enhance accuracy and efficiency.

Critical Skills Required

• Strong computer skills, including proficiency in MS Office.
• Excellent verbal and written communication skills.
• Strong interpersonal skills and ability to work collaboratively in a team environment.
• Expert knowledge of the Healthcare domain with a focus on claims processing.
• Experience in Government Operations (Medicare and Medicaid).
• Strong understanding of insurance terminology: Copay, Coinsurance, Deductible, and Out-of-Pocket.
• Ability to explain Medicare and Medicaid eligibility in detail.
• Experience as a Claims Examiner Level III for at least 3 years.
• Knowledge of Corrected Claims Processing, CPT and HCPCS codes.
• Ability to understand California claims contract language.
• Basic mathematical and analytical skills for claims benefit/out-of-pocket calculations.
• Ability to coordinate benefits with Medicare and Medicaid.

Thanks & Regards

Misam Raza

Sr. Talent Acquisition Specialist

Diverse Lynx| 300 Alexander Park Suite| #200|Princeton, NJ 08540

Mobile- 732-582-8414

Office- 732-452-1006 , Ext:285

Email- [email protected] | URL- https://www.diverselynx.com/

LinkedIn- linkedin.com/in/connect2misam