Claims Processor - Remote / Telecommute - Cynet Systems : Job Details

Claims Processor - Remote / Telecommute

Cynet Systems

Job Location : all cities,AK, USA

Posted on : 2025-07-14T05:50:41Z

Job Description :
Job Description:
  • The Claims Processor is responsible for examining and resolving non-adjudicated claims, ensuring timely payments, and calculating deductibles and maximums.
  • The role involves using automated systems to ensure accurate claim completion based on medical policies, contracts, and procedures.
  • The Claims Processor also collaborates with multiple departments, provides feedback, and answers basic processing questions while contributing to performance data for leadership.
Responsibilities:
  • Examine and resolve non-adjudicated claims by identifying key processing requirements based on contracts, policies, and procedures.
  • Process product or system-specific claims to ensure timely payments, calculating deductibles, and resolving pending claims.
  • Use automated systems to send pending claims for accurate completion according to medical policies and procedures.
  • pply training materials, correspondence, and medical policies to ensure claims are processed accurately.
  • Collaborate with the Quality team for clarification on procedures and difficult claims, receiving coaching from leadership.
  • Participate in ongoing developmental training to improve performance.
  • Complete daily productivity data to provide performance statistics for leadership, helping with scheduling, quality improvement, workflow design, and financial planning.
  • Collaborate with multiple departments to provide feedback, resolve issues, and answer basic processing questions.
Skills:
  • Strong analytical skills.
  • Proficient in reading comprehension and following provided directions.
  • Basic written and oral communication skills.
  • Proficiency in navigating computer applications.
  • bility to effectively work in a fast-paced environment with changing priorities and deadlines.
  • bility to meet established deadlines and handle multiple customer service demands.
  • Strong customer service skills to handle challenging situations and provide positive experiences to internal and external customers.
Qualification or Education:
  • High School Diploma or GED.
  • 3+ years of experience in processing claim adjudication.
  • Experience with processing Inter-Plan Teleprocessing System (ITS) Claims.
Preferred Attributes:
  • 5+ years of claims processing, adjudication, or medical terminology experience.
  • Experience with LuminX claims processing system.
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