Group Health Claims Processor

Join a team that delivers excellence.

Lehigh Valley Health Network (LVHN) is home to nearly 23,000 colleagues who make up our talented, vibrant and diverse workforce.

Join our team and experience firsthand what it's like to be part of a health care organization that's nationally recognized, forward-thinking and offers plenty of opportunity to do great work.

Imagine a career at one of the nation's most advanced health networks.

Be part of an exceptional health care experience. Join the inspired, passionate team at Lehigh Valley Health Network, a nationally recognized, forward-thinking organization offering plenty of opportunity to do great work.

LVHN has been ranked among the "Best Hospitals" by U.S. News & World Report for 23 consecutive years. We're a Magnet(tm) Hospital, having been honored five times with the American Nurses Credentialing Center's prestigious distinction for nursing excellence and quality patient outcomes in our Lehigh Valley region. Finally, Lehigh Valley Hospital - Cedar Crest, Lehigh Valley Hospital - Muhlenberg, Lehigh Valley Hospital- Hazleton, and Lehigh Valley Hospital - Pocono each received an 'A' grade on the Hospital Safety Grade from The Leapfrog Group in 2020, the highest grade in patient safety. These recognitions highlight LVHN's commitment to teamwork, compassion, and technology with an unrelenting focus on delivering the best health care possible every day.

Whether you're considering your next career move or your first, you should consider Lehigh Valley Health Network.

Reviews and adjudicates claims in accordance with claim processing guidelines. Provides accurate and timely resolution in processing claims. Provides customers with prompt, efficient, high quality claim service.

Job Duties

• Reviews and researches insurance claims to determine benefits and to maintain expected department turnaround time.
• Adjudicates claims within the required productivity and quality levels.
• Validates members, providers, and other claims information.
• Uses multiple systems and screens to efficiently process claim.
• Determines and understands benefit coverage provided under a member's health plan.
• Completes pricing of claims according to guidelines and contract agreements.
• Identifies procedures requiring review and refers to appropriate team with all required documentation.
• Achieves and maintains total claim and pay dollar accuracy on random and high dollar audits.
• Adheres to all procedures to ensure compliance with HIPAA standards and regulations.
• Participates in making suggestions to improve workflow, quality, and quantity of production.

• High School Diploma/GED
• 2 years Experience in the insurance/healthcare industry and
• 2 years Experience in CPT, HCPC, ICD-10 codes and
• 2 years Previous claims adjudication experience and
• 2 years Previous direct claim experience handling group health claims
• Ability to function under pressure and deadlines.
• Must possess the initiative to identify and carry out responsibilities to their completion.
• Strong problem solving abilities and analytical skills.

Lift and carry 7 lbs., continuous sitting >67%, frequent keyboard use/repetitive motion, frequent fine motor activity/wrist position deviation.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Lehigh Valley Health Network is an equal opportunity employer. In accordance with, and where applicable, in addition to federal, state and local employment regulations, Lehigh Valley Health Network will provide employment opportunities to all persons without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity, disability or other such protected classes as may be defined by law. All personnel actions and programs will adhere to this policy. Personnel actions and programs include, but are not limited to recruitment, selection, hiring, transfers, promotions, terminations, compensation, benefits, educational programs and/or social activities.

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