Insurance Claims Processor
WVU Medicine · Remote (US)
- Review and oversee the adjudication of insurance claims at WVU Medicine ranging from simple data entry to complex specialty claim research.
- Analyze and process insurance claims, checking for validity; determine whether to return, deny, or pay claims while following organizational policies and procedures.
- Screen, review, evaluate online entry, correct errors, and perform quality control for final adjudication of paper/electronic claims.
- Determine accuracy and completion of claim information; resolve claim edits, review history records, and determine benefit eligibility for service.
- Review payment levels to arrive at final payment determination; maintain work queues per department standards; escalate issues to supervision as appropriate.
- Requires HS diploma/GED and one year of medical or institutional claim data entry OR one year of customer service experience; associate degree in healthcare preferred.
- Remote full-time role reporting to the Claims Manager; effective communication and attention to production/quality standards essential.
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