Delta Health Systems, one of the leading Third Party Administrators (TPA) for self insured programs in the country with a reputation for flexibility, innovative services and outstanding customer service is looking for an innovative, self motivated, dedicated individual to fill the position of:

Claims Processor

• Evaluate claims, determine payment or denial according to Plan provisions, Medical Policy, and guidelines.
• Process claim payment thoroughly, attend all training, and refresher courses.    
• Maintain clear claim notes, benefit quote documentation, thoroughly review patient and family notes. 
• Maintain multiple network access for pricing and authorization to avoid inactivity and disruption for processing.
• Establish and maintain COB files, applies COB payments for final claim payment.
• Applies COB payments for final claim payment.
• Research and determine proper CPT procedure and ICD-10 Diagnosis Codes.
• Research and respond to written correspondence from participants, providers, and local unions/employers.
• Transfer claims to Benefit Review for processing instructions and or other departments according to guidelines.  
• Work effectively to achieve at a minimum production, quality, and accuracy standards.
• Display maturity, composure and ability to operate under stress conditions.
• Follow department policy and procedures distributed.
• Attend mandatory department meetings as scheduled.
• Assist other department areas as required dependent on workload and inventory needs.
• Excellent organization and assignment management skills.
• Clear communication with internal and external customers.
• Ability to Navigate in external network pricing platforms.
• Ability to prioritize workload and adhere to network administrative agreements.
• Maintains professionalism at all times.
• Perform other duties as assigned.