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Claims Processor I Pgba Jobs in Indiana (NOW HIRING)

Elevance Health

Claims Representative I

Indianapolis, IN · On-site

$16.23 - $24.36/hr

Claims Representative I Claims Representative I Location : This role enables associates to work ... Codes and processes claims forms for payment ensuring all information is supplied before eligible ...

Aon

Claims Professional I

Elkhart, IN · On-site

$60K - $80K/yr

Claims Professional I Aon is looking for a Claims Professional I in our Ft. Wayne, IN office. This ... process and to perform essential job functions once onboard. The salary range for this position ...

Elevance Health

Claims Representative I

Indianapolis, IN · On-site

$16.23 - $24.36/hr

Claims Representative I Location : This role enables associates to work virtually full-time, except ... Codes and processes claims forms for payment ensuring all information is supplied before eligible ...

HUB

Commercial Claims Advocate

Indianapolis, IN

... their loss, i.e. coverage disputes, policy interpretation, settlement disputes, etc ... Good computer skills with proficiency in email, word processing and spreadsheet software as well as ...

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Claims Processor I Pgba information

What is the difference between Claims Processor I Pgba vs Claims Processor II?

AspectClaims Processor I PgbaClaims Processor II
Required CredentialsHigh school diploma or equivalent; basic insurance knowledgeHigh school diploma; some experience or certification preferred
Work EnvironmentEntry-level, clerical setting within insurance companiesMore complex claims processing, possibly supervisory tasks
Employer & Industry UsageCommon in insurance companies, healthcare providersUsed in similar settings, often with increased responsibilities

The main difference between Claims Processor I Pgba and Claims Processor II lies in experience and responsibilities. Claims Processor II typically handles more complex claims and may assist or supervise Claims Processor I Pgba roles. Both positions require similar credentials but differ in scope and expertise.

What does a Claims Processor I PGBA do?

A Claims Processor I PGBA is responsible for reviewing, processing, and adjudicating insurance claims in accordance with company policies and industry regulations. They verify the accuracy of information, determine eligibility, and ensure claims are processed efficiently and correctly. This entry-level position often involves communicating with policyholders, healthcare providers, and other stakeholders to resolve discrepancies or gather additional information. Attention to detail and knowledge of insurance procedures are essential for success in this role.

What are the key skills and qualifications needed to thrive as a Claims Processor I PGBA, and why are they important?

To thrive as a Claims Processor I PGBA, you need strong attention to detail, analytical skills, and a high school diploma or equivalent. Familiarity with claims processing software, data entry systems, and knowledge of insurance or healthcare terminology are typically required. Exceptional organizational skills, time management, and effective communication set top performers apart. These abilities ensure accurate and timely processing of claims, reducing errors and supporting customer satisfaction in a high-volume environment.

What are some common challenges faced by a Claims Processor I at PGBA, and how can they be successfully managed?

Claims Processors at PGBA often encounter challenges such as high volumes of claims, strict accuracy requirements, and tight deadlines. Successfully managing these involves strong attention to detail, effective time management, and familiarity with claims processing software. Collaboration with team members and clear communication with supervisors can help resolve complex cases efficiently. Continuous learning about updated policies and procedures also plays a key role in overcoming daily obstacles.
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Claims Processor I Pgba jobs near you
Claims Auditor- Remote

Claims Auditor- Remote

American Health Partners

Indianapolis, IN • Hybrid

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 21 days ago

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. 

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! 

Benefits and Perks include:

  • Affordable Medical/Dental/Vision insurance options
  • Generous paid time-off program and paid holidays for full time staff
  • TeleMedicine 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts
  • Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation. 

  • Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
  • Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
  • Work assigned claim projects to completion
  • Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
  • Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
  • Maintain production and quality standards as established by management
  • Participate in and support ad-hoc audits as needed
  • Other duties as assigned

JOB REQUIREMENTS:

  • Proficient in processing/auditing claims for Medicare and Medicaid plans
  • Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
  • Current experience with both Institutional and Professional claim payments
  • Knowledge of automated claims processing systems
  • Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:

  • Experience:
    • Two (2) years’ experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
    • Two (2) years’ experience in managed healthcare environment related to claims processing/audit
    • Two (2) years’ experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
    • Two (2) years’ experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
    • Two (2) years’ experience processing/auditing claims for Medicare and Medicaid plans
  • License/Certification(s):
    • Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

 This employer participates in E-Verify.

American Health Partners logo

About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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