Claims Clerk

Position Overview

Smart IT Frame LLC is seeking skilled Claims Processors for a contract-based remote role within the healthcare sector. This position involves assessing and processing medical claims accurately and efficiently for a prominent healthcare client.

Key Responsibilities

• Evaluate medical claims alongside their relevant documentation.
• Decide eligibility and appropriate payment amounts for claims.
• Ensure claims comply with established standard operating procedures and accuracy standards.
• Achieve defined monthly targets related to productivity and quality.
• Maintain thorough records of claim processing and audit trails.
• Provide daily status updates to team leadership.

Qualifications and Skills

• Experience in healthcare or medical claims processing.
• Knowledge of claims adjudication processes.
• Familiarity with Medicaid and Medicare claims.
• Exceptional attention to detail.
• Ability to perform effectively in fast-paced, production-oriented environments.

Preferred Experience

• Exposure to payer organizations such as Centene, Optum, Anthem, Humana, Molina, or Aetna.
• Use of claims management software like Facets or QNXT.

About Smart IT Frame

Smart IT Frame leverages over 10 years of experience in staffing to connect top talent with leading organizations across the United States. The company specializes in IT, healthcare, and professional placements, aiming to foster growth for both employers and candidates.