Must-Have:
• Must have a Laptop/computer with internet to work from home.
• Comfortable providing a Photo ID Copy
Terms of Employment:
• W2 Contract, 12 Months (Possible Extension / Permanent Conversion)
• This position is 100% remote. Candidates must be based in Maryland, Washington, DC, Virginia, West Virginia, Pennsylvania, Delaware, New Jersey, New York, North Carolina, or Florida.
Overview & Responsibilities:
Join a leading healthcare organization as a Claims Processor. You will play a vital role in ensuring the accurate and timely processing of insurance claims within a TPA environment. This is an excellent opportunity for a detail-oriented professional to manage complex claims and contribute to a high-impact team. You will…
• Process healthcare claims using LuminX and ITS (Inter-Plan Teleprocessing System) platforms.
• Conduct research and validate issues to ensure accurate claim adjudication.
• Manage complex claims featuring secondary payments, including Medicare and other insurance providers.
• Handle high-volume claims that may include over 50 line items per claim.
• Identify key elements for processing and ensure adherence to medical policies.
• Collaborate with a "buddy" and the Hiring Manager during a comprehensive three-week training period.
Required Qualifications:
• Minimum of 1+ year recent, dedicated experience in claims processing (less than 12 months will not be considered).
• Proven ability to perform time management and independent research.
• Knowledgeable of / familiarity with ICD-10 standards.
• Experience in Medicare claims processing.
• Excellent written and verbal communication skills with a desire to work in a team environment.
• Experienced using Microsoft Office – namely Excel and Outlook.
• Must have a Windows-based computer setup (MacBooks are incompatible with client systems).
• Ability to work 100% remotely on Eastern Standard Time (EST).
Preferred Qualifications:
• Prior experience with LuminX or ITS/Blue Card systems.
• Experience working within a TPA (Third Party Administrator) environment.
• Experience with claims adjustments or medical policy application.