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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare claims processing, including knowledge of CPT, HCPCS, ICD-10, and medical terminology. Proven ability to analyze claim data, meet productivity targets, and mentor junior team members while collaborating effectively across teams.
Highest-signal resume keywords
Healthcare Claims ProcessingCPT CodingICD-10 CodingClaims Data AnalysisTeam Collaboration
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationMedical TerminologyBilling KnowledgeCPTHCPCSICD-10UB04CMS 1500Data ReviewProcess Documentation
Soft Skills
Strong Work EthicAdaptabilityMentoringTeam PlayerCommunication
Tools & Technologies
Claims Processing SystemVideo Technology
Industry Keywords
HealthcareClaims ProcessingProvider DataAuthorizationsEnrollment
About the role
Key responsibilities & impact- Report to the Claims Team Leader
- Adjudicate healthcare claims using specified policies and procedures
- Review data in the claims processing system to determine whether services were appropriate and benefit coverage criteria were met
- Review adjudication system edits to determine whether claims or line items should be paid
- Process assigned claims according to client-specified guidelines or team leader direction
- Meet productivity targets and financial and procedural accuracy standards
- Mentor junior team members
- Collaborate on special projects, including process documentation, training, quality audits, surge activity support, and other assigned work
- Communicate with management about issues and concerns and take preventive measures to ensure processing accuracy and quality
- Participate in projects involving provider data, authorizations, enrollment, or other assigned activities
- Work across multiple time zones using video technology
Requirements
What you’ll need- High School degree required
- 1–3 years healthcare claims processing experience
- Solid understanding and ability to analyse claim data
- Knowledge of physician practices and hospital coding, billing, and medical terminology
- Knowledge of CPT, HCPCS, ICD-10, UB04, CMS 1500, authorizations, and healthcare concepts
- ICD-10, CPT, and HCPCS coding is a plus
- Willingness to learn new skills
- Team collaboration ability
- Strong work ethic
- Ability to adapt quickly to a fast-paced environment
- Self-starter and quick learner
- Ability to collaborate as a team player
- Candidates may be required to undergo a pre-employment criminal background check
Benefits
Comp & perks- Full-time, permanent employment
- Remote work environment
- Hybrid or remote work environment
- May require travel dependent on company needs
- Reasonable accommodations for individuals with disabilities in compliance with the Americans with Disabilities Act of 1990