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Claims Processor

ATR International
Mesa, Arizona, 85210, United States
July 16, 2018

Job Title: Claims Processor 2

Job Location: Mesa, AZ

Job Duration: 5 months

Job Description:

We are seeking a Claims Processor 2 for a very important client.

The main function of a Claims Processor is to process claims for companies and process new claims, modify existing ones, and obtain information from claimants. They have to analyze the data that they are given to recommend an informed decision and keep with their company's standards.

Enter information from claims into data systems and process claims and arrange for claim resolution. Answer inquiries regarding claims details. Enter information from claims into data systems and process claims and arrange for claim resolution. Submitting appeals/reconsiderations to payers for incorrectly processed claims. Answer inquiries regarding claims details. Manual identification, sorting and redistribution of misdirected correspondence. Data entry of claims into PCRS or ECS application for auto-pricing Manual pricing/handling of claims for retailers and their customers. Process all new claim pricing inventory in manual mailboxes for dual platform/networks Pricing identification of errors and management of resolution with provider contracting/maintenance internal teams. Identifies steps necessary to process a varying complexity of contracts for pricing accuracy. Researches, analyzes and calculates claims in accordance with provider contracts. Works with internal matrix partners to resolve pended claims issues. Enter payment information to the NDC 11 level into the First Rebate System Work with the billing department for any discrepancies with payments. Quality check entries made by the other claims processors. Contact manufacturers for payment backup as needed. Provide backup support to other team/group members in the performance of job duties as assigned. Track and report data entered on weekly metric reporting. Maintain and update required reference materials used in the data entry process


The ideal candidate will possess the following qualifications:


Strong reliability and attendance. Strong customer service skills, excellent ability to communicate claims information to customers. Ability to work in a fast paced environment. Intermediate Excel experience preferred.


High school diploma or equivalent. Previous data entry experience, claims or healthcare experience a plus 2-4 years experience. Secondary Commercial Claims for NV/AZ.