Medical Claims Processor

Kforce is seeking Medical Claims Examiners for a fully remote contract role, requiring candidates to be located within two hours of Aurora, CO. Key responsibilities include coordinating claim operations, monitoring workflow to meet goals, and ensuring adherence to guidelines and regulations. The role involves applying knowledge of medical claim/bill payment processing and medical regulations, utilizing organizational policies for compliance, researching claims, and responding to vendor and member inquiries. Candidates must have a minimum of three years of experience in full claims adjudication, specifically processing paid medical claims.

Must Have

• Located within 2 hours of Aurora, CO
• High School diploma or General Education Development (GED) required
• Minimum of 3 years of experience in claims processing
• Experience in a medical claims processing environment
• Experience doing full claims adjudication from start to finish
• Processing paid medical claims

Perks & Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• HSA
• FSA
• 401(k)
• Life insurance
• Disability insurance
• ADD insurance
• Paid time off (for salaried personnel or as required by law for hourly)
• Paid sick leave (for hourly on Service Contract Act project)

Description

Kforce has a client that is looking to hire Medical Claims Examiners. The role is fully remote, but candidates need to be located within 2 hours of the client's primary office site in Aurora, CO. Top Daily Responsibilities:

• Medical Claims Examiner coordinates claim operations and modifications with other areas of the organization
• Monitors workflow to achieve established goals and objectives
• Responsible for abiding by all guidelines, procedures, and policies
• Learning and applying knowledge of medical claim/bill payment processing and medical regulations
• As a Medical Claims Examiner, you will utilize knowledge of organizational policies and procedures to ensure adherence to contractual agreements and non-contracted pricing arrangements along with compliance with government regulations
• Researches claims/bills for appropriate support documents and documentation
• Responds to vendor and member problems, questions and complaints

Requirements

• High School diploma or General Education Development (GED) required
• Qualified candidates will have a minimum of 3 years of experience in claims processing, ideally in a medical claims processing environment
• Must have experience doing full claims adjudication from start to finish and processing paid medical claims. (i.e., Processing medical claims that are paying out to the Providers and not from the Providers to insurance.