Health Insurance Claims Processor

About the Company

The organization employs over 4,500 team members dedicated to enhancing the healthcare experience. Recognized among the Top 100 Healthiest Workplaces and World’s Most Ethical Companies, their long-standing commitment to people shapes their efforts to simplify, improve, and make healthcare more affordable for the 3.3 million individuals covered under their regional health plans. Rooted in a century of transformation, they continue innovating to provide seamless, personalized care into the future.

Position Overview

We are searching for a Health Insurance Claims Processor to join a dynamic operations team focused on the prompt and accurate handling of healthcare claims. This role requires keen attention to detail, analytical problem solving, and a strong commitment to quality and productivity in a fast-paced setting.

Role Responsibilities

• Accurately process healthcare claims by reviewing necessary documentation, checking eligibility and benefit details, and applying contractual guidelines across various claim types.
• Investigate and resolve inconsistencies in claims by analyzing data carefully and applying sound decision-making to ensure proper adjudication.
• Review, correct, and reprocess claims when needed while maintaining comprehensive records and audit trails.
• Confirm pricing information, coordination of benefits, and other claim specifics to support correct payment assessments.
• Provide professional responses to questions from members, providers, and internal partners, clearly explaining claims processes.
• Consistently meet expectations for productivity, quality, accuracy, attendance, and turnaround times within a high-volume environment.
• Adapt quickly to changes in procedures, benefit plans, claims systems, and team priorities while maintaining accuracy.
• Identify issues in processing, suggest system enhancements or documentation updates, and communicate proposals to relevant stakeholders.
• Assist with inventory management, reporting, training, and other assigned departmental projects.
• Maintain confidentiality and adhere to all organizational policies and regulatory requirements.

Candidate Requirements

• High school diploma or equivalent is mandatory.
• A minimum of two years’ office experience, ideally in health insurance claims processing, medical billing, medical office operations, or similar administrative roles.
• Preferred experience in claims processing or researching health benefits and contract application.
• Proficiency in Microsoft Office, including Outlook, Word, and Excel.
• Strong data entry skills, excellent keyboarding, basic math skills, and high attention to detail.
• Ability to analyze moderately complex claims information and make informed judgments.
• Excellent written and verbal communication skills with a customer-service orientation.
• Capability to manage multiple tasks independently while collaborating with team members.
• Adeptness at rapidly acquiring new system knowledge, procedures, and claims guidelines.
• Comfort working in a fast-paced environment, consistently achieving production and quality benchmarks.
• Flexibility to work potential overtime or travel occasionally as required.

Additional Information

This is a 12-month contract role paying $20 per hour. The position is fully remote; however, applicants must reside in North Dakota, Oregon, Washington, Utah, or Idaho and commit to Central Time Zone working hours from 8:00 AM to 4:30 PM.