Remote Claims Data Entry Specialist Jobs | Medical Claims Processor Jobs Work From Home

By | April 13, 2022

Job Responsibilities : Medical Claims Processor-Work From Home

Salary : $18 per hour

Company : Presbyterian Healthcare Services

Location : Remote US

Educational requirements : High School

Competencies and skills:

  • SKILL-Ability to effectively interact with customers to understand their needs and explain data
  • SKILL-Microsoft Office
  • Planning and coordinating organizational change
  • Anticipating & Addressing Customer Needs
  • Functioning as an Effective Contingent Member
  • Acquiring & Applying Superior Skills to achieve Quality Outcomes
  • Functioning as an Effective Team Member
  • SKILL-Demonstrated ability to communicate effectively in person and via telephone with members employer groups brokers physicians and physician office staff using strong dialogue and customer service competencies.
  • SKILL-Written communication


  • Processes and adjusts inpatient and outpatient medical claims according to departmental quality and production standards.
  • Pends claims as directed by departmental policies and procedures follows up for resolution and processes pended claims immediately following a benefit/payment determination.
  • Identifies patterns in resubmitted and adjusted claims. Identifies errors and inconsistencies that require revisions to claim guidelines or system modifications
  • Ability to process claims requiring special handling (i.e. Case Management Transplants Negotiations and processes coordination of benefits (COB) as required.
  • Uses online policies and procedures to ensure accurate and consistent processing of claims.
  • Performs follow up and takes all necessary actions required to resolve all errors and findings assessed by the Internal Audit department.

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