Claims Processing Executive

Immediate need for a talented Claims Processing Executive. This is a 06+months contract opportunity with long-term potential and is located in IOWA(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-22885

Pay Range: $19/hr - $20/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
• Core platform – QNXT claims experienced - Preferred
• MUST HAVE CLAIMS and FACETS experience
• Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
• Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
• Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
• Documentation: Record claim activity, maintain audit trails, and prepare reports for management.

Key Requirements and Technology Experience: 

• High school diploma or equivalent REQUIRED
• Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers).
• 2–4 years of experience in US healthcare claims processing
• Familiarity with claims management software and EDI transactions.
• Excellent analytical, organizational, and communication skills.
• Ability to interpret insurance policies and payer guidelines.
• Detail-oriented with strong problem-solving abilities.
• Competencies-
• Regulatory Knowledge – Deep understanding of US healthcare laws and payer requirements.
• Accuracy & Detail Orientation – Ensures claims are processed correctly and efficiently.
• Problem-Solving – Resolves claim disputes and denials effectively."

Our client is a leading IT Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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