About this opportunity
About the Role:
We are currently seeking Skilled Claims Processors to join our team. We are seeking an experienced Claims Processor to support the accurate review, processing, and adjudication of health and dental insurance claims while ensuring compliance with plan benefits, regulatory requirements, and company policies.
Job Title : Claims Processors
Location: Plantation, FL (On-Site)
Employment Type: Full-Time
Key Responsibilities:
- Review and process medical and dental claims accurately and efficiently
- Apply member benefits, deductibles, maximums, frequency limitations, and coordination of benefits (COB)
- Process claims adjustments, reprocessing, refunds, and corrected claims
- Review claim documentation, narratives, and supporting records
- Research and resolve claims inquiries from providers, members, and internal teams
- Document claim actions and maintain accurate records
- Ensure compliance with HIPAA and company policies
- Meet productivity, quality, and turnaround time expectations
- Identify trends, errors, or processing issues and escalate as appropriate
Qualifications:
- 2+ years of health or dental claims processing experience
- Knowledge of claims adjudication processes
- Experience with EOBs (Explanation of Benefits) and Coordination of Benefits (COB)
- Strong attention to detail and data accuracy
- Strong communication and customer service skills
- Experience using claims processing systems
- Proficiency with Microsoft Office and multiple systems
- Ability to work in a fast-paced production environment
- Preferred Qualifications
- Experience with dental claims and CDT codes
- Experience with Medicare Advantage, Medicaid, or commercial insurance plans
- Prior claims adjustment and reprocessing experience
- Bilingual English/Spanish
- Healthcare insurance or managed care experience
If you're looking to grow your career in healthcare claims operations, we'd love to hear from you.
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