Senior Claims Processor III

Job description:

Senior Claims Processor III

Location: Visalia, CA
Employment Type: Temp-to-Hire
Industry: Healthcare / Medical Insurance

Position Overview:

Key Staffing is partnering with a leading healthcare organization in Visalia that is seeking an experienced Senior Claims Processor III. This position is responsible for processing complex medical claims while ensuring accuracy, compliance, and timely adjudication.

The ideal candidate will have extensive experience processing high-dollar facility claims, a strong understanding of medical terminology and coding, and the ability to independently research and resolve complex claims issues. This role also serves as a resource for junior claims processors and assists with escalated provider and member inquiries.

Key Responsibilities

• Claims Processing
• Process complex inpatient, outpatient, and high-dollar facility claims.
• Review and adjudicate medical claims accurately and efficiently.
• Verify claim accuracy, coding, and payment information.
• Interpret contracts and ensure claims are processed in accordance with applicable guidelines.
• Maintain productivity and quality standards while meeting processing deadlines.

Research & Resolution

• Independently research and resolve complex claims issues.
• Investigate discrepancies and coordinate with internal departments as needed.
• Handle escalated provider and member inquiries professionally and efficiently.
• Ensure all claims are processed in compliance with company policies and industry regulations.

Leadership & Support

• Serve as a mentor and resource for lower-level Claims Processors.
• Provide guidance on claims processing procedures and best practices.
• Assist in maintaining a high level of quality and accuracy across the claims team.

Qualifications/Required Experience

• 3–7+ years of health claims processing experience.
• Experience processing inpatient, outpatient, and high-dollar facility claims.
• Extensive knowledge of:
• Medical terminology
• CPT coding
• HCPCS coding
• ICD coding
• Knowledge of Coordination of Benefits (COB).
• Ability to interpret provider contracts and reimbursement guidelines.
• Strong analytical, problem-solving, and research skills.
• Experience handling escalated provider and member inquiries.
• Previous experience mentoring or training junior claims processors.

Preferred Qualifications

• Associate's or Bachelor's degree in Healthcare Administration or a related field.
• Facility coding and/or medical billing credential preferred.

Technical Skills

• Claims processing systems
• Microsoft Office Suite
• Medical billing and coding software
• Data entry and electronic documentation

Commitment to Diversity: As an equal opportunity employer committed to meeting the needs of a multi-generational and multicultural workforce, Key Staffing recognizes that a diverse staff, reflective of our community, is an integral and welcome part of a successful and ethical business. We hire local talent at all levels regardless of race, color, religion, age, national origin, gender, gender identity, sexual orientation, or disability and actively foster inclusion in all forms both within our company and across interactions with clients, candidates, and partners.