Claims Processor-Customer Service
CorrectCare - Integrated Health - Lexington, KY

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Position Title: Claims Processor

Position Summary: The Claims Processor works both independently and in conjunction with claim supervisor to adjudicate claims, respond to provider or client inquiries in an accurate and courteous manner according to CCIH mission, vision and values.

Essential Functions:
  • Process payment or denial of all types of medical claims, professional and hospital, using the designated claims processing system in the designated timeframe.
  • Respond to customer or provider inquiries regarding claims status.
  • Provide excellent customer service.
  • Research/request information regarding payment of claims.
  • Print letters, (Denial, Additional information etc.)
  • Perform various duties assigned by management.

Qualifications (Education, Training, Experience, Competencies):
  • High School diploma or equivalent.
  • 2 – 5 years prior claims processing experience.
  • Excellent customer service skills.
  • CPC certification preferred.
  • Experience with ICD-9, CPT/HCPCS coding, medical terminology, HCFA 1500s and UB92s.
  • Strong communication, analytical, organizational and problem-solving skills.
  • Accurate data-entry skills.
  • Excellent time management skills.
  • Proficient with Microsoft applications (Work, Excel, Outlook) and database systems.

Physical Demands:
  • Use hands to operate equipment such as personal computer, telephone console, calculator or adding machine.
  • Utilize close vision to perform activities such as reading and personal computer.
Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.
  • Work takes place primarily in the corporate office