Claims Processing - Claims Processor I

Community Care is hiring a Claims Processor I. This rewarding opportunity is perfect for someone who enjoys team collaboration, being part of a mission driven organization and who shares our mission to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community. This is a full-time opportunity at our Waukesha Office. Duties & Responsibilities: · Accurately keys claims data into the claims processing system and resolves routine edits up to assigned complexity, according to established Claims Department policies and procedures. · Performs assigned workload within established timeframes to assure Claims turnaround time goals are met.· Resolves issues before claims payment to avoid re-adjudication.· Refers complex claims or claims falling out of standard policies and procedure guidelines to Team Leader.· Performs other duties as assigned.· Protects privacy and maintains confidentiality of sensitive employee, participant, and agency information.· Meets departmental performance goals, which are measured by meeting claims turnaround time, individual productivity, quality, and accuracy of work completed.Qualifications & Requirements:Education: High school diploma required.Experience: Prior health care and/or managed care claims processing experience in a healthcare payer or provider setting is preferred, though not required. Skills & Knowledge:· General knowledge of claims processing regulations, systems, and procedures is preferred.· A good understanding of HCPCs, CPT and ICD 9/10 coding and medical terminology.· Intermediate skills in Microsoft Office (Excel, Word, Outlook, etc.) and virtual communication applications such as Microsoft Teams, Zoom, Webex, etc. Excellent verbal and written communicationskills and attention to detail.· Strong critical thinking, problem-solving, decision-making skills.· Ability to quickly adapt and learn new technologies and procedures as they are implemented in the workplace.· Productive as both an individual and team contributor.· Adhere to company policies and local, state, and federal guidelines when facilitating claims processing · Ability to maintain confidentiality.· Dependable, resourceful and flexible.· Ability to work sensitively and effectively with individuals of diverse ethnic and cultural backgrounds.· Pleasant and patient. Other:· Occasional travel between sites is necessary.About Community Care Community Care is a local nonprofit with more than 40 years of experience helping older adults and adults with disabilities live as independently as possible within the community. We coordinate and deliver a full range of supportive services that help more than 13,000 Wisconsin residents live safely, confidently, and with dignity. We are Wisconsin-based with local offices supporting each of the 15 counties we serve. Our dedicated team works with members to develop care plans to meet their health and social needs. Together with our community partners, we’re committed to providing compassionate, personalized care that empowers members to live a healthy and independent lifestyle.Compensation and Benefits: Our employees make a real difference in people’s lives every day that is why we are proud to offer a compensation package that includes:Attractive full and part time schedulesGenerous paid time offCompetitive pay and benefits (health, dental, vision, etc.) Retirement Plan with employer contributionFlexible benefits planEmployee referral programCo-Workers care programEmployee Assistance ProgramCOVID-19 Vaccination Policy Community Care’s mandatory COVID-19 vaccination policy require all employees to be fully vaccinated or have an approved medical or religious exemption. Community Care is an Equal Opportunity Employer