Role: Claims Processing Executive
Location: Remote
Contract: 6+ Months
Job Summary
Join our team as a Claims Processing Executive in the healthcare sector, leveraging your MS Excel and QNXT claims processing expertise to manage and process commercial claims. This remote, day-shift role offers work-from-home flexibility while contributing to accurate claims adjudication, operational efficiency, and customer satisfaction.
Responsibilities
Claims Processing: Review, validate, and process healthcare claims per US insurance policies.
QNXT Platform: Hands-on experience with QNXT claims processing is required.
Eligibility Verification: Confirm coverage, benefits, and pre-authorization requirements for Medicare, Medicaid, and commercial plans.
Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
Compliance: Ensure adherence to HIPAA, CMS, and other US healthcare regulations.
Documentation: Maintain claim records, audit trails, and management reports.
Required Skills & Qualifications
High school diploma or equivalent (required).
Strong knowledge of US healthcare insurance systems, including Medicare, Medicaid, and commercial payers.
2 to 4 years of US healthcare claims processing experience.
Experience with claims management systems and EDI transactions.
Strong analytical, organizational, communication, and problem-solving skills.
Ability to interpret insurance policies and payer guidelines.
Competencies
Regulatory Knowledge: Strong understanding of US healthcare regulations and payer requirements.
Accuracy & Attention to Detail: Ensures efficient and error-free claims processing.
Problem-Solving: Effectively resolves claim denials, discrepancies, and disputes.