Claims Processor

Delta Health Systems

. Evaluate claims and determine payment or denial according to Plan provisions, Medical Policy, and guidelines .

Posted 11/5/2026full-timeFresno • California • United StatesJunior💰 $21 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims processing, including evaluating claims, determining payments, and applying medical terminology. Proficient in maintaining documentation and adhering to departmental guidelines while ensuring quality and accuracy in claim handling.

Highest-signal resume keywords

Claims Processing ExperienceMedical Terminology KnowledgeCPT Procedure ResearchICD-10 Diagnosis Code ResearchWritten And Oral Communication Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims EvaluationClaim Payment ProcessingCOB File MaintenanceNetwork Pricing NavigationDocumentation MaintenanceGuideline InterpretationQuality Standards AdherenceWorkload PrioritizationMedical Policy UnderstandingBenefit Quote Documentation

Soft Skills

Good Judgment SkillsAbility To Interpret GuidelinesCommunication Skills

Certifications & Qualifications

High School Diploma Or EquivalentMedical Terminology Course Completion

Industry Keywords

Claims ProcessorDepartment PoliciesProduction StandardsAuthorization ProcessesPatient And Family Notes

About the role

Key responsibilities & impact

Evaluate claims and determine payment or denial according to Plan provisions, Medical Policy, and guidelines
Process claim payment thoroughly
Attend training and refresher courses
Maintain clear claim notes and benefit quote documentation
Review patient and family notes
Maintain multiple network access for pricing and authorization
Establish and maintain COB files and apply 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 or other departments according to guidelines
Meet production, quality, and accuracy standards
Follow department policies and procedures
Attend mandatory department meetings
Assist other department areas according to workload and inventory needs
Perform other duties as assigned

Requirements

What you’ll need

High school diploma or equivalent
Satisfactory completion of medical terminology course may substitute for six (6) months of equivalent experience
Eighteen (18) months experience as a Claims Processor or similar function
Broad knowledge of medical terminology
Excellent written and oral communication skills
Good judgment skills and ability to interpret Department guidelines and contractual benefits
Ability to navigate external network pricing platforms
Ability to prioritize workload and adhere to network administrative agreements
Any employee who is not in a probationary status and meets the qualifications of this position shall be eligible to apply