Sr Claims Processor

Sr Claims Processor

SummaCare - 1200 E Market St, Akron, OH

Full-Time / 40 Hours / Days

• Remote after training

Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Summary:

Responsible for the accurate and timely handling of claims in accordance with regulatory and contractual guidelines. Reviews claims related to coordination of benefits, medical coding, authorization assignments, and necessary sub-system updates. Applies cost-containment techniques when working with vendor partners to minimize claim costs while ensuring adherence to plan-specific and line-of-business processing rules. Responsibilities include, but are not limited to, repricing reconciliation and case agreement claim processing. May mentor junior processors to support team development.

1. Formal Education Required:

a. High School Diploma or equivalent

2. Experience & Training Required:

a. Two (2) years performing same or similar responsibilities.

b. Similar responsibilities include any combination of the following:

i. health insurance claims processing,

ii. health claims data entry including Document Management Services (DMS),

iii. customer service experience in a managed care environment,

iv. physician or hospital billing,

v. patient accounts

3. Other Skills, Competencies and Qualifications:

a. Word and Excel at a basic level. Must achieve passing score on test administered by Human Resources.

b. Skilled in medical terminology, CPT, HCPCs, and ICD-10

c. Understanding of professional (CMS1500) and institutional (UB-04) claim types

d. Health claims processing knowledge

e. Close attention to detail with independent judgment, decision making and problem solving skills

f. Strong analytical skills with the ability to interpret complex data sets and draw meaningful conclusions

g. Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity

4. Level of Physical Demands:

a. Sit for prolonged periods of time

b. Bend, stop and stretch

c. Lift up to 20 pounds

d. Manual dexterity to operate computer, phone and standard office machines

Equal Opportunity Employer/Veterans/Disabled

$20.51/hr - $24.61/hr

The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.

Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.

• Basic Life and Accidental Death & Dismemberment (AD&D)
• Supplemental Life and AD&D
• Dependent Life Insurance
• Short-Term and Long-Term Disability
• Accident Insurance, Hospital Indemnity, and Critical Illness
• Retirement Savings Plan
• Flexible Spending Accounts - Healthcare and Dependent Care
• Employee Assistance Program (EAP)
• Identity Theft Protection
• Pet Insurance
• Education Assistance
• Daily Pay