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Claim processor jobs in Albuquerque, NM - 27 jobs
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Medical Claims Representative - Workers' Compensation (Albuquerque)
Cannon Cochran Management
Claim processor job in Albuquerque, NM
Workers' Compensation Medical Only Claim Representative Schedule: Monday-Friday, 8:00 a.m. - 4:30 p.m. (37.5 hours per week) Compensation: $20.00 per hour Build Your Career With Purpose at CCMSI At CCMSI, we partner with global clients to solve their most complex risk management challenges, delivering measurable results through advanced technology, collaborative problem-solving, and an unwavering commitment to their success. We don't just process claims-we support people. As the largest privately-owned Third Party Administrator (TPA), CCMSI delivers customized claim solutions that help our clients protect their employees, assets, and reputations. We are a certified Great Place to Work , and our employee-owners are empowered to grow, collaborate, and make meaningful contributions every day. Job SummaryThe Workers' Compensation Medical Only Claim Representative is responsible for managing medical-only workers' compensation claims for multiple client accounts across various industries. This position focuses on the timely and accurate adjudication of claims in compliance with New Mexico statutes, client expectations, and CCMSI standards. It offers structured training, mentorship, and the opportunity to develop foundational adjusting skills in a collaborative, in-office environment. Responsibilities Adjudicate medical-only workers' compensation claims timely and accurately in accordance with statutory, client, and CCMSI guidelines. Establish and maintain claim reserves within authority levels under direct supervision. Review, approve, and negotiate medical and miscellaneous invoices to ensure appropriate and related charges. Coordinate and monitor medical treatment in compliance with corporate claim standards. Document all claim activity, medical updates, and correspondence in the claim system. Close claim files when appropriate and assist with file maintenance as needed. Provide support to the broader claim team, including client service initiatives and administrative tasks. Maintain compliance with all Corporate Claim Standards and client-specific handling instructions. Qualifications Required: Associate degree or two (2) years of related business experience NM Adjuster's License or ability to obtain within 60 days of hire (must pass state licensing exam and background check) Proficiency in Microsoft Office (Word, Excel, Outlook) Preferred / Nice to Have: Previous workers' compensation or claim handling experience Knowledge of medical terminology is very helpful Bilingual (Spanish) proficiency - highly valued for communicating with claimants, employers, or vendors, but not required. Why You'll Love Working Here 4 weeks (Paid time off that accrues throughout the year in accordance with company policy) + 10 paid holidays in your first year Comprehensive benefits: Medical, Dental, Vision, Life, and Disability Insurance Retirement plans: 401(k) and Employee Stock Ownership Plan (ESOP) Career growth: Internal training and advancement opportunities Culture: A supportive, team-based work environment How We Measure Success At CCMSI, great adjusters stand out through ownership, accuracy, and impact. We measure success by: Quality claim handling - thorough investigations, strong documentation, well-supported decisions Compliance & audit performance - adherence to jurisdictional and client standards Timeliness & accuracy - purposeful file movement and dependable execution Client partnership - proactive communication and strong follow-through Professional judgment - owning outcomes and solving problems with integrity Cultural alignment - believing every claim represents a real person and acting accordingly This is where we shine, and we hire adjusters who want to shine with us. Compensation & Compliance The posted salary reflects CCMSI's good-faith estimate in accordance with applicable pay transparency laws. Actual compensation will be based on qualifications, experience, geographic location, and internal equity. This role may also qualify for bonuses or additional forms of pay. CCMSI offers comprehensive benefits including medical, dental, vision, life, and disability insurance. Paid time off accrues throughout the year in accordance with company policy, with paid holidays and eligibility for retirement programs in accordance with plan documents. Visa Sponsorship: CCMSI does not provide visa sponsorship for this position. ADA Accommodations: CCMSI is committed to providing reasonable accommodations throughout the application and hiring process. Equal Opportunity Employer: CCMSI complies with all applicable employment laws, including pay transparency and fair chance hiring regulations. Background checks, if required for the role, are conducted only after a conditional offer and in accordance with applicable fair chance hiring laws. Our Core Values At CCMSI, we believe in doing what's right-for our clients, our coworkers, and ourselves. We look for team members who: Lead with transparency We build trust by being open and listening intently in every interaction. Perform with integrity We choose the right path, even when it is hard. Chase excellence We set the bar high and measure our success. What gets measured gets done. Own the outcome Every employee is an owner, treating every claim, every decision, and every result as our own. Win together Our greatest victories come when our clients succeed. We don't just work together-we grow together. If that sounds like your kind of workplace, we'd love to meet you. #CareerDevelopment #ClaimsTraining #WorkersCompensation #InsuranceCareers #AlbuquerqueJobs #NowHiring #LearnAndGrow #EmployeeOwned #GreatPlaceToWorkCertified #CCMSICareers #AdjusterJobs #BilingualJobs #IND456 #LI-InOfficeWe can recommend jobs specifically for you! Click here to get started.$20 hourly Auto-Apply 8d agoClaims Examiner
Partnered Staffing
Claim processor job in Albuquerque, NM
Every day, Kelly Services connects professionals with opportunities to advance their careers. In addition to working with the world's most recognized and trusted name in staffing, Kelly employees can expect: Competitive pay Paid holidays Year-end bonus program Portable 401(k) plans Recognition and incentive programs Access to continuing education via the Kelly Learning Center Kelly Services is a U.S.-based Fortune 500 company.With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world. For 70 years, Kelly Services has provided outstanding employment opportunities to the most talented individuals in the marketplace. Today, we are proud to offer a Claims Examiner position for a top company located in Albuquerque, NM Job Description This position is responsible for processing complex insurance claims, requiring further investigation and coordination of benefits. Also responsible for resolving pending claims. Qualifications High school diploma or equivalent. 6 months data entry experience OR 6 months experience in a medical office environment. Analytical and organizational skills and independent decision making skills. Ability to use discretion in working with confidential information. Clear and concise written and verbal communication skills Experience processing medical claims Additional Information IMPORTANT INFORMATION: This position is being recruited by a remote office, not your local Kelly branch. To be considered for this position, please send your resumes to romt021 @kellyservices.com$30k-46k yearly est. 2d agoMedical Coding Analyst I or II - Must have a NM Residence
UNM Medical Group, Inc.
Claim processor job in Albuquerque, NM
Job Description UNM Medical Group, Inc. is hiring for a Medical Coding Analyst I or II to join our Coding Department. This opportunity is a REMOTE, full-time and day shift opening located in New Mexico. *This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico* *This position is remote, however the selected candidate would need to be available to come into the office in Albuquerque, New Mexico if they experience network or laptop issues* *Sign-On Bonus: $2,000* Medical Coding Analyst 1: Minimum $44,604 - Midpoint $55,766* *Salary is determined based on years of total relevant experience. *Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Medical Coding Analyst 2: Minimum $52,038 - Midpoint $65,043* *Salary is determined based on years of total relevant experience. *Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Responsible for coding Inpatient/Outpatient charges and specialty services using appropriate ICD and CPT classification systems for the purpose of reimbursement, research and compliance in accordance with federal regulation. Charges include all Inpatient/Outpatient visits, Day Surgeries, consultations and observation accounts. Specialty services include Interventional Radiology, GI Lab, Pathology, Cardiac Cath Lab, Vascular Lab, Orthopedics, Surgical and Anesthesia procedures. Responsible for review of documentation in medical records to assure that documentation by providers conforms to compliance and legal requirements. Provide feedback for practitioners on coding practices. Coder must meet department productivity and quality standards. Ensure adherence to policies and procedures and guidelines. Minimum Job Requirements or a Medical Coding Analyst I: High School diploma or GED and 6 months directly related experience or successful completion of UNMMG Medical Coding Internship Program. Certification in at least one of the following: RHIT, RHIA, RCC, CIRCC, CSS, CCA, CCS-P, COC, CIC, CPC, CPC-P or CPC-A. Verification of education and licensure (if applicable) will be required if selected for hire. Minimum Job Requirements or a Medical Coding Analyst II: High School diploma or GED and 2 years directly related experience. Certification in at least one of the following: RCC, CPC, CIRCC, CPC-P, CCS, CCS-P, COC, CIC, RHIA, or RHIT. Verification of education and licensure (if applicable) will be required if selected for hire. Duties and Responsibilities: Reviews and analyzes medical records in order to assign appropriate CPT and ICD-10 codes for inpatient and outpatient consultations, procedures, anesthesia, inpatient visits, and office visits for new or established patients. Analyzes as well as resolution of coding edits that occur. Identifies and reviews documentation in an EMR environment to ensure that all required signatures and addendums are present in the medical record(s). Interaction and feedback to providers, when necessary, regarding medical documentation deficiencies or to request clarification of documentation components. Ensures strict confidentiality of medical records and documentation. Follows established departmental policies, procedures and objectives. Why Join UNM Medical Group, Inc.? Since our creation in 2007, our dynamic organization has continued to grow and form strong partnerships within the UNM Health system. Modern Healthcare recognizes UNMMG in their Best Places to Work recognition for 2025. We ASPIRE to incorporate the following values into all aspects of our culture and work: we always demonstrate an Attitude of Service with Positivity, Integrity and Respect as we strive for Excellence. We are dedicated to embracing and promoting diversity while fostering well-being across New Mexico through cultural humility and respect for everyone. Benefits: Competitive Salary & Benefits: UNMMG provides a competitive salary along with a comprehensive benefits package. Insurance Coverage: Includes medical, dental, vision, and life insurance. Additional Perks: Offers tuition reimbursement, generous paid time off, and a 403b retirement plan for eligible employees.$36k-50k yearly est. 11d agoAdjudicator, Provider Claims-On the phone
Molina Healthcare Inc.
Claim processor job in Albuquerque, NM
Provides support for provider claims adjudication activities including responding to providers to address claim issues, and researching, investigating and ensuring appropriate resolution of claims. * Provides support for resolution of provider claims issues, including claims paid incorrectly; analyzes systems and collaborates with respective operational areas/provider billing to facilitate resolution. * Collaborates with the member enrollment, provider information management, benefits configuration and claims processing teams to appropriately address provider claim issues. * Responds to incoming calls from providers regarding claims inquiries - provides excellent customer service, support and issue resolution; documents all calls and interactions. * Assists in reviews of state and federal complaints related to claims. * Collaborates with other internal departments to determine appropriate resolution of claims issues. * Researches claims tracers, adjustments, and resubmissions of claims. * Adjudicates or readjudicates high volumes of claims in a timely manner. * Manages defect reduction by identifying and communicating claims error issues and potential solutions to leadership. * Meets claims department quality and production standards. * Supports claims department initiatives to improve overall claims function efficiency. * Completes basic claims projects as assigned. Required Qualifications * At least 2 years of experience in a clerical role in a claims, and/or customer service setting, including experience in provider claims investigation/research/resolution/reimbursement methodology analysis within a managed care organization, or equivalent combination of relevant education and experience. * Research and data analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Customer service experience. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software programs proficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $21.65 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.$21.7-38.4 hourly 26d agoClaims Specialist
New Mexico Mutual Casualty Company
Claim processor job in Albuquerque, NM
Job Title: Claims Specialist Department: Claims Reports To: Claims Manager This position provides expert claim handling services in the areas of coverage, compensability, investigation, evaluation, negotiation, litigation management and resolution of serious and complex workers' compensation insurance claims under applicable law, corporate policy and best practice. Quality claim handling expertise, Service Excellence and indemnity and expense management will also be provided by the position. The claims specialist will also be an expert technical resource to other claims professionals, business partners, policyholders and stakeholders. Essential Functions: Evaluate, analyze and determine compensability, causation, offsets and exposures of serious and complex workers compensation insurance claims in accordance with applicable law, corporate policy, best practice and prescribed authorities Verify claim information including but not limited to: documentation of the claim history; taking recorded statements from workers and witnesses, identify subrogation opportunities, coordination of medical care. Document all activities in the claim management system. Responsible for outside legal counsel assignments, RTW strategies with policyholders, implement medical case management strategies with nurse case managers and all other expert assignments. Upon determination of compensability: Set and monitor reserves according to company policies and the worker's injury, issue benefit checks in accordance to statutory requirements, and demonstrate proficiency in the application of state statutes, related case law and to interpret and comply with company claims standards, policies and procedures. Must have above-average knowledge, understanding and ability to apply case law to claim handling practices. Ensure the timely and accurate statutory/benefit payments within the established time frames and guidelines. Prepare and participate in mediation conferences and other authorized legal or regulatory proceedings before the regulatory agencies and courts of law. Maintain a diary on all open claims. Document all relevant information to provide a clear history of events and a proper audit trail. Set review dates based on claim complexity or standard review criteria. Assess and report claims litigation for significant financial exposure, case law precedent or reputation risk. Identify and recommend claims with potential for full and final settlement and negotiate and/or coordinate with authorized outside legal counsel in full and final settlements. Analyze assigned claims to identify trends and opportunities for improvement of policies, procedures and controls, and prepare related reports. Mentor junior adjusters and provide support to Claims Managers as directed. Detect and report reasonable suspicions of insurance fraud by claimants, medical or legal providers, policyholders or other individuals related to claims. Maintain claim records in compliance with applicable law, corporate policies and retention schedules. Requirements Job Qualifications: Education: Bachelor's Degree from an accredited college or university. Experience: 5+ years of serious workers' compensation claims experience. 10+ claims handling experience. Specialized Knowledge, Licenses, etc.: Demonstrated proficiency in: Related professional certifications preferred State required adjuster's license Values and Mission: Adhere to values and mission by demonstrating Service Excellence, Trust, Ownership, One team and Boldness in thought and action. Positive Attitude: Develops and maintains positive working relationships with team members, customers, co-workers and management by demonstrating effective communication and collaborative skills. Working Conditions: NEW MEXICO MUTUAL maintains general office conditions with light physical demands, with occasional lifting. Employees of NEW MEXICO MUTUAL adhere to all safety rules and regulations including building security. Employees participate in ensuring safe and efficient operating conditions that safeguard employees and facilities. NEW MEXICO MUTUAL maintains a drug free environment; drug testing prior to employment as well as upon a work related accident. Exposure to VDT screens.$36k-52k yearly est. 14d agoClaims Specialist - Journal Center, (121)
Tricore Reference Laboratories
Claim processor job in Albuquerque, NM
Scheduled Shift: Monday-Friday 8:00am-5:00pm and other shifts as needed. Responsible for collecting accounts receivables on patient accounts, non-government and contracted insurances government payers and secondary billing. Responsibilities include routine follow-up on accounts, working the Rejection Report for contracted insurances, analyzing aged trial balance report for assigned charge to's, working the Antrim, Rhodes reports and miscellaneous accounts receivable reports. ESSENTIAL FUNCTIONS: 1. Collects outstanding accounts receivables on patient accounts from patient, commercial, non-government, contracted insurances or government payors via phone call to the patient or insurance company or by means of written appeal or reconsideration. 2. Pursues collection activities on assigned accounts from primary and secondary payors until worked to resolution to include claims resubmission, appeal or reconsideration. 3. Works account receivables reports (i.e. aged-trial-balance report), focusing attention on accounts over 60 days. 4. Researches adjustments and pull all necessary backup to support adjustments. 5. Utilizes on-line insurance resources to obtain and maintain current information. 6. Develops and maintains a professional working rapport with internal and external customers to include contacts with insurance company representatives. 7. Identifies trends in payment or non-payment of claims. Communicates findings to leadership and co-workers as appropriate. 8. Customizes reports in Antrim and or Excel to prioritize accounts for collecting. The above statements describe the general nature and level of work being performed by individuals assigned to this classification. This is not intended to be an exhaustive list of all responsibilities and duties required of personnel so classified. MINIMUM EDUCATION: High school diploma or equivalent MINIMUM EXPERIENCE: Must have one of the following: Six (6) months as an Apprentice in the Business Office at TriCore Minimum of one (1) year of laboratory or medical claims follow-up/collections experience Minimum of three (3) years of medical billing or claims processing experience OTHER REQUIREMENTS: Must be able to type 30 words per minute (typing test required) Must have basic PC knowledge and working expertise with keyboard, mouse, Internet, and Windows based applications PREFERENCES: Basic knowledge of Excel and Word Knowledge of medical terminology IMMUNIZATION REQUIREMENTS: Prove immunity to Hepatitis B or be immunized or sign a waiver refusing hepatitis immunization. Provide documentation of a PPD test conducted not more than 90 days prior to date of hire or have a PPD test conducted. GENERAL REQUIREMENTS: 1. Proficient in PC/data entry skills 2. Must be able to work independently with little direction and to demonstrate sound judgment and problem solving skills 3. Ability to resolve problems and follow up as needed or appropriate 4. Effective communication skills and telephone skills 5. Ability to deal with difficult clients and patients 6. Strong working knowledge of insurance and reimbursement$38k-62k yearly est. 60d+ agoClaims Investigator - Experienced
Command Investigations
Claim processor job in Albuquerque, NM
Job Description Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer. Powered by JazzHR RPlQMliA1V$36k-49k yearly est. 24d agoClaims - Field Claims Representative
Cincinnati Financial Corporation
Claim processor job in Albuquerque, NM
Make a difference with a career in insurance At The Cincinnati Insurance Companies, we put people first and apply the Golden Rule to our daily operations. To put this into action, we're looking for extraordinary people to join our talented team. Our service-oriented, ethical, knowledgeable, caring associates are the heart of our vision to be the best company serving independent agents. We help protect families and businesses as they work to prevent or recover from a loss. Share your talents to help us reach for continued success as we bring value to the communities we serve and demonstrate that Actions Speak Louder in Person. If you're ready to build productive relationships, collaborate within a diverse team, embrace challenges and develop your skills, then Cincinnati may be the place for you. We offer career opportunities where you can contribute and grow. Build your future with us Our Field Claims department is currently seeking field claims representatives to service the territory surrounding: Albuquerque, New Mexico. The candidate is required to reside within the territory. This territory allows either an experienced or entry-level representative the opportunity to investigate and evaluate multi-line insurance claims through personal contact to ensure accurate settlements. Be ready to: * complete thorough claim investigations * interview insureds, claimants, and witnesses * consult police and hospital records * evaluate claim facts and policy coverage * inspect property and auto damages and write repair estimates * prepare reports of findings and secure settlements with insureds and claimants * use claims-handling software, company car and mobile applications to adjust loss in a paperless environment * provide superior and professional customer service * once eligible, become a certified and active Arbitration Panelist To be an Entry Level Claims Representative: The pay range for this position is $55,000 - $76,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * a desire to learn about the insurance industry and provide a great customer experience * the ability to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * a bachelor's degree * AINS, AIC, or CPCU designations preferred Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match To be an Experienced Claims Representative: The pay range for this position is $62,000 - $90,000 annually. The pay determination is based on the applicant's education, experience, location, knowledge, skills and abilities. Eligible associates may also receive an annual cash bonus and stock incentives based on company and individual performance. Be equipped with: * be available and communicative during your regular business hours * multi-line claims experience preferred * ability to completely assess auto, property, and bodily injury type damages * capacity to work unsupervised * excellent verbal and written communication skills * strong interpersonal skills * excellent problem-solving, negotiation, organizational, and prioritization skills * preparedness to follow-up with others in a timely manner * a valid driver's license Bring education or experience from: * one or more years of claims handling experience * AINS, AIC, or CPCU designations preferred * bachelor's degree or equivalent experience required Benefits in addition to compensation include: * company car * company stock options, including Restricted Share Units and Incentive based stock options * paid time off (PTO) * 401K with 6% company match Enhance your talents Providing outstanding service and developing strong relationships with our independent agents are hallmarks of our company. Whether you have experience from another carrier or you're new to the insurance industry, we promote a lifelong learning approach. Cincinnati provides you with the tools and training to be successful and to become a trusted, respected insurance professional - all while enjoying a meaningful career. Enjoy benefits and amenities Your commitment to providing strong service, sharing best practices and creating solutions that impact lives is appreciated. To increase the well-being and satisfaction of our associates, we offer a variety of benefits and amenities. Embrace a diverse team As a relationship-based organization, we welcome and value a diverse workforce. We grant equal employment opportunity to all qualified persons without regard to race; creed; color; sex, including sexual orientation, gender identity and transgender status; religion; national origin; age; disability; military service; veteran status; pregnancy; AIDS/HIV or genetic information; or any other basis prohibited by law. All job applicants have rights under Federal Employment Laws. Please review this information to learn more about those rights.$62k-90k yearly 49d agoPre-Certification Specialist
New Mexico Orthopaedic Associates P C
Claim processor job in Albuquerque, NM
Responsible for timely verification of benefits and prior authorizations for all physicians and physical therapists. ESSENTIAL RESPONSIBILITIES: Updates and maintains patient demographics as needed. Verify eligibility of benefits from the provider's schedule, real time, 3 days prior to scheduled appointments. Review credentialing for accuracy and contract information. Verify referrals if needed and obtain referral from PCP. Obtain eligibility and prior authorizations for DME, assigned surgeries and outside testing and physical therapy. Coordinate with Front Office, Medical Records, Medical Assistants and Account Representatives on above data. Maintains files with insurance authorizations and referral information. Assist in covering team member's work, when others are out. Works overtime hours as needed. Adheres to company policies as described in employment handbook and company work rules. Participates in professional development activities and opportunities. Attends staff meeting and others as required. Maintains confidentiality of patient account information in accordance with HIPAA guidelines and NMOA policy. Regular and reliable attendance. Performs any other duties as assigned. SUPERVISORY RESPONSIBILITIES: N/A KNOWLEDGE, SKILLS AND ABILITIES: To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required. Exceptional customer service skills. Knowledge of current basic medical terminology, coding, eligibility and prior authorization knowledge and office procedures. Strong computer and phone skills, including multi-line phones. Excellent grammar and spelling skills. Ability to establish and maintain effecting working relationships with staff, co-workers, patients and vendors. Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, decimals and percentages. Ability to understand, read, write and speak English. Ability to understand and speak Spanish preferred. Ability to read, analyze and interpret medical information, technical procedures and/or general business information. Ability to effectively present information, respond to questions and professionally interact with managers, employees, patients, vendors and the general public. Ability to recognize and define problems, collect data, establish facts, draw conclusions and correct errors. Ability to interpret a variety of instructions in a variety of forms and deal with abstract and concrete variables. Ability to handle multiple simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner. Exhibit understanding of healthcare regulatory and compliance policy (e.g., HIPAA). Knowledge of New Mexico Orthopaedics policies and procedures to include Operating Agreement, Medical Staff Bylaws, Business Office Standards and Recommended Practices. Requires ability to identify and implement opportunities to improve performance of the department. High integrity, including maintenance of confidential information. Exhibit patience in high stress situations and handle confrontations with poise and efficiency. Ability to work a flexible schedule, including some evenings and weekends. May be assigned to or transferred to any clinic location, depending upon business need PHYSICAL DEMANDS AND WORK ENVIRONMENT: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job responsibilities. While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; or smell. The employee must occasionally lift and/or move up to 20 pounds. Repetitive motion of upper body required for extended use of computer. Requires vision correctable to 20/20 and hearing in the normal range for face-to-face and telephone contacts. Works in well-lit, ventilated and climate controlled office environment with routine office equipment; some equipment has moving mechanical parts. Noise level in the work environment is usually moderate. Qualifications EDUCATION AND/OR EXPERIENCE: High School Diploma or GED and two years of relevant experience. Pre-verification and Prior Authorization experience in a medical office setting preferred. CERTIFICATIONS, LICENSES, REGISTRATIONS: None required$28k-56k yearly est. 11d agoClaims Examiner
Partnered Staffing
Claim processor job in Albuquerque, NM
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly. Job Title: Claims Examiner Pay Rate: $ 12.50 - up to $ 13.50 per hour Start Date: Monday, December 19, 2016 Type: Temporary-to-Hire Shift: 8 hour shift between 6AM-6PM) Job Description Overview: Attention to Detail Perfect Attendance First 6 weeks during Training period 6-12 months of office experience · Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims · Review and compare information in computer systems and apply proper codes/documentation · May place outgoing calls to providers and/or pharmacies for further investigation before processing claims Job Specific Qualifications: · High school diploma or GED · Data Entry and/or typing experience · Clear and concise written and verbal communication skills · Ability to multi task and prioritize is required · Interpersonal, verbal and written communication skills · Ability to sit for long periods of time · Analytical and problem solving skills · Must be dependable and flexible Kelly Services Benefits and Perks: In addition to working with the world's most recognized and trusted name in staffing, Kelly employees can expect: - Competitive pay - Paid holidays - Year-end bonus program - Portable 401(k) plans - Recognition and incentive programs - Access to continuing education via the Kelly Learning Center Additional Information Instructions : Please call 641-424-3614 for more information on how to apply! Why Kelly? As a Kelly Services candidate you will have access to numerous perks, including: Exposure to a variety of career opportunities as a result of our expansive network of client companies Career guides, information and tools to help you successfully position yourself throughout every stage of your career Access to more than 3,000 online training courses through our Kelly Learning Center Group-rate insurance options available immediately upon hire* Weekly pay and service bonus plans$30k-46k yearly est. 2d agoSenior Analyst, Claims Research
Molina Healthcare
Claim processor job in Albuquerque, NM
The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. **Job Duties** + Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual requirements + Expertly tailors existing reports or available data to meet the needs of the claims project + Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error + Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. + Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. + Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. + Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. + Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. + Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. + Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. + Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. + Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + 5+ years of experience in medical claims processing, research, or a related field. + Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. + Advanced knowledge of medical billing codes and claims adjudication processes. + Strong analytical, organizational, and problem-solving skills. + Proficiency in claims management systems and data analysis tools + Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. + Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. + Microsoft office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Bachelor's Degree or equivalent combination of education and experience + Project management + Expert in Excel and PowerPoint + Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$80.2k-106.2k yearly 7d agoClaims Investigator - Experienced
Command Investigations
Claim processor job in Albuquerque, NM
Seeking experienced investigators with commercial or personal lines experience, with multi-lines preferred to include AOE/COE, Auto, and Homeowners. SIU experience is highly desired, but not required. We are seeking individuals who possess proven investigative skill sets within the industry, as well as honesty, integrity, self-reliance, resourcefulness, independence, and discipline. Good time management skills are a must. Must have reliable transportation, digital recorder and digital camera. Job duties include, but are not limited to, taking in-person recorded statements, scene photos, writing a detailed, comprehensive report, client communications, as well as meeting strict due dates on all assignments. If you have the desire to operate at your highest professional level within an organization that values and rewards excellence, please submit your resume. Only the finest individuals are considered for hire. Visit our website and find out why at ****************** The Claims Investigator should demonstrate proficiency in the following areas: AOE/COE, Auto, or Homeowners Investigations. Writing accurate, detailed reports Strong initiative, integrity, and work ethic Securing written/recorded statements Accident scene investigations Possession of a valid driver's license Ability to prioritize and organize multiple tasks Computer literacy to include Microsoft Word and Microsoft Outlook (email) Full-Time benefits Include: Medical, dental and vision insurance 401K Extensive performance bonus program Dynamic and fast paced work environment We are an equal opportunity employer.$36k-49k yearly est. Auto-Apply 60d+ agoClaims Examiner
Partnered Staffing
Claim processor job in Albuquerque, NM
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly. Job Description Overview · Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims · Review and compare information in computer systems and apply proper codes/documentation · May place outgoing calls to providers and/or pharmacies for further investigation before processing claims Qualifications Job Specific Qualifications · High school diploma or GED · Data Entry and/or typing experience · Clear and concise written and verbal communication skills · Ability to multi task and prioritize is required · Interpersonal, verbal and written communication skills · Ability to sit for long periods of time · Analytical and problem solving skills · Must be dependable and flexible Additional Information All your information is kept confidential as per EEO standards. Why is this a great opportunity? The answer is simple…working at our client is more than a job; it's a career. The opportunities are diverse whether you are right at the start of your career or whether you are looking for new challenges this is the job for you, so be quick and apply now!$30k-46k yearly est. 2d agoSenior Analyst, Claims Research
Molina Healthcare Inc.
Claim processor job in Albuquerque, NM
The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. Job Duties * Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects * Assists with reducing re-work by identifying and remediating claims processing issues * Locate and interpret regulatory and contractual requirements * Expertly tailors existing reports or available data to meet the needs of the claims project * Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error * Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. * Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. * Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. * Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. * Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. * Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. * Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. * Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. * Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. Job Qualifications REQUIRED QUALIFICATIONS: * 5+ years of experience in medical claims processing, research, or a related field. * Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. * Advanced knowledge of medical billing codes and claims adjudication processes. * Strong analytical, organizational, and problem-solving skills. * Proficiency in claims management systems and data analysis tools * Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. * Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. * Microsoft office suite/applicable software program(s) proficiency PREFERRED QUALIFICATIONS: * Bachelor's Degree or equivalent combination of education and experience * Project management * Expert in Excel and PowerPoint * Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $106,214 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.$80.2k-106.2k yearly 8d agoClaims Examiner
Partnered Staffing
Claim processor job in Albuquerque, NM
Every day, Kelly Services connects professionals with opportunities to advance their careers. In addition to working with the world's most recognized and trusted name in staffing, Kelly employees can expect: Competitive pay Paid holidays Year-end bonus program Portable 401(k) plans Recognition and incentive programs Access to continuing education via the Kelly Learning Center Kelly Services is a U.S.-based Fortune 500 company.With our global network of branch locations, we are uniquely positioned to provide our customers with international staffing support and our employees with diverse assignments around the world. For 70 years, Kelly Services has provided outstanding employment opportunities to the most talented individuals in the marketplace. Today, we are proud to offer a Claims Examiner position for a top company located in Albuquerque, NM Job Description This position is responsible for processing complex insurance claims, requiring further investigation and coordination of benefits. Also responsible for resolving pending claims. Qualifications High school diploma or equivalent. 6 months data entry experience OR 6 months experience in a medical office environment. Analytical and organizational skills and independent decision making skills. Ability to use discretion in working with confidential information. Clear and concise written and verbal communication skills Experience processing medical claims Additional Information IMPORTANT INFORMATION: This position is being recruited by a remote office, not your local Kelly branch. To be considered for this position, please send your resumes to romt021 @kellyservices.com$30k-46k yearly est. 60d+ agoSenior Analyst, Claims Research
Molina Healthcare
Claim processor job in Rio Rancho, NM
The Senior Claims Research Analyst provides senior-level support for claims processing and claims research. The Sr. Analyst, Claims Research serves as a senior-level subject matter expert in claims operations and research, leading the most complex and high-priority claims projects. This role involves advanced root cause analysis, regulatory interpretation, project management, and strategic coordination across multiple departments to resolve systemic claims processing issues. The Sr. Analyst provides thought leadership, develops remediation strategies, and ensures timely and accurate project execution, all while driving continuous improvement in claims performance and compliance. Additionally, the Sr. Analyst will represent the organization internally and externally in meetings, serving as a key liaison to communicate findings and resolution plans effectively. **Job Duties** + Uses advanced analytical skills to conduct research and analysis for issues, requests, and inquiries of high priority claims projects + Assists with reducing re-work by identifying and remediating claims processing issues + Locate and interpret regulatory and contractual requirements + Expertly tailors existing reports or available data to meet the needs of the claims project + Evaluates claims using standard principles and applicable state specific policies and regulations to identify claims processing error + Act as a senior claims subject matter expert, advising on complex claims issues and ensuring compliance with regulatory and contractual requirements. + Leads and manages major claims research projects of considerable complexity, initiated through provider inquiries, complaints, or internal audits. + Conducts advanced root cause analysis to identify and resolve systemic claims processing errors, collaborating with multiple departments to define and implement long-term solutions. + Interprets regulatory and contractual requirements to ensure compliance in claims adjudication and remediation processes. + Develops, tracks, and / or monitors remediation plans, ensuring claims reprocessing projects are completed accurately and on time. + Provides in-depth analysis and insights to leadership and operational teams, presenting findings, progress updates, and results in a clear and actionable format. + Takes the lead in provider meetings, when applicable, clearly communicating findings, proposed solutions, and status updates while maintaining a professional and collaborative approach. + Proactively identifies and recommends updates to policies, SOPs, and job aids to improve claims quality and efficiency. + Collaborates with external departments and leadership to define claims requirements and ensure alignment with organizational goals. **Job Qualifications** **REQUIRED QUALIFICATIONS:** + 5+ years of experience in medical claims processing, research, or a related field. + Demonstrated expertise in regulatory and contractual claims requirements, root cause analysis, and project management. + Advanced knowledge of medical billing codes and claims adjudication processes. + Strong analytical, organizational, and problem-solving skills. + Proficiency in claims management systems and data analysis tools + Excellent communication skills, with the ability to tailor complex information for diverse audiences, including executive leadership and providers. + Proven ability to manage multiple projects, prioritize tasks, and meet tight deadlines in a fast-paced environment. + Microsoft office suite/applicable software program(s) proficiency **PREFERRED QUALIFICATIONS:** + Bachelor's Degree or equivalent combination of education and experience + Project management + Expert in Excel and PowerPoint + Familiarity with systems used to manage claims inquiries and adjustment requests To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $80,168 - $106,214 / ANNUAL *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.$80.2k-106.2k yearly 7d agoClaims Examiner
Partnered Staffing
Claim processor job in Albuquerque, NM
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly. Job Description Overview · Under supervision, this position is responsible for processing complex claims requiring further investigation, including coordination of benefits, and resolving pended claims · Review and compare information in computer systems and apply proper codes/documentation · May place outgoing calls to providers and/or pharmacies for further investigation before processing claims Qualifications Job Specific Qualifications · High school diploma or GED · Data Entry and/or typing experience · Clear and concise written and verbal communication skills · Ability to multi task and prioritize is required · Interpersonal, verbal and written communication skills · Ability to sit for long periods of time · Analytical and problem solving skills · Must be dependable and flexible Additional Information All your information is kept confidential as per EEO standards. Why is this a great opportunity? The answer is simple…working at our client is more than a job; it's a career. The opportunities are diverse whether you are right at the start of your career or whether you are looking for new challenges this is the job for you, so be quick and apply now!$30k-46k yearly est. 60d+ agoAnalyst, Claims Research
Molina Healthcare Inc.
Claim processor job in Albuquerque, NM
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.$25k-37k yearly est. 8d agoClaims Examiner
Partnered Staffing
Claim processor job in Albuquerque, NM
At Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talent to drive their business forward. If you only make one career connection today, connect with Kelly. Job Description TITLE : Claims Examiner-Centennial Care Department SHIFT : Monday- Friday PAY : $12.50 - $14.00 per hour LOCATION : Albuquerque, NM Kelly Services, Inc. is currently seeking to place Claims Examiners in temporary to hire positions in Albuquerque, NM RESPONSIBILITIES : This position is responsible for processing complex insurance claims, requiring further investigation and coordination of benefits. Also responsible for resolving pending claims. REQUIREMENTS : · 6 months data entry experience (7,000 ksph) OR 3 months experience in a medical office environment. · High school diploma OR GED · Analytical and organizational skills and independent decision making skills. · Clear and concise written and verbal communication skills · Experience processing medical claims Additional Information All your information is kept confidential as per EEO standards. Why is this a great opportunity? The answer is simple…working at our client is more than a job; it's a career. The opportunities are diverse whether you are right at the start of your career or whether you are looking for new challenges this is the job for you, so be quick and apply now!$12.5-14 hourly 2d agoAnalyst, Claims Research
Molina Healthcare Inc.
Claim processor job in Rio Rancho, NM
Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are appropriately applied, identifying root-cause of processing errors through research and analysis, coordinating and engaging with appropriate departments, developing and tracking remediation plans, and monitoring claims reprocessing through resolution. Essential Job Duties * Serves as claims subject matter expert - using analytical skills to conduct research and analysis to address issues, requests, and support high-priority claims inquiries and projects. * Interprets and presents in-depth analysis of claims research findings and results to leadership and respective operations teams. * Manages and leads major claims projects of considerable complexity and volume that may be initiated internally, or through provider inquiries/complaints, or legal requests. * Assists with reducing rework by identifying and remediating claims processing issues. * Locates and interprets claims-related regulatory and contractual requirements. * Tailors existing reports and/or available data to meet the needs of claims projects. * Evaluates claims using standard principles and applicable state-specific regulations to identify claims processing errors. * Applies claims processing and technical knowledge to appropriately define a path for short/long-term systematic or operational fixes. * Seeks to improve overall claims performance, and ensure claims are processed accurately and timely. * Identifies claims requiring reprocessing or readjudication in a timely manner to ensure compliance. * Works collaboratively with internal/external stakeholders to define claims requirements. * Recommends updates to claims standard operating procedures (SOPs) and job aids to increase the quality and efficiency of claims processing. * Fields claims questions from the operations team. * Interprets, communicates, and presents, clear in-depth analysis of claims research results, root-cause analysis, remediation plans and fixes, overall progress, and status of impacted claims. * Appropriately conveys claims-related information and tailors communication based on targeted audiences. * Provides sufficient claims information to internal operations teams that communicate externally with providers and/or members. * Collaborates with other functional teams on claims-related projects, and completes tasks within designated/accelerated timelines to minimize provider/member impacts and maintain compliance. * Supports claims department initiatives to improve overall claims function efficiency. Required Qualifications * At least 3 years of medical claims processing experience, or equivalent combination of relevant education and experience. * Medical claims processing experience across multiple states, markets, and claim types. * Knowledge of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid, and Marketplace government-sponsored programs. * Data research and analysis skills. * Organizational skills and attention to detail. * Time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. * Ability to work cross-collaboratively in a highly matrixed organization. * Customer service skills. * Effective verbal and written communication skills. * Microsoft Office suite (including Excel), and applicable software programs proficiency. Preferred Qualifications * Health care claims analysis experience. * Project management experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $22.81 - $46.42 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.$25k-37k yearly est. 8d ago
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Learn more about claim processor jobs
How much does a claim processor earn in Albuquerque, NM?
The average claim processor in Albuquerque, NM earns between $24,000 and $57,000 annually. This compares to the national average claim processor range of $26,000 to $62,000.
Average claim processor salary in Albuquerque, NM
$37,000
What are the biggest employers of Claim Processors in Albuquerque, NM?
The biggest employers of Claim Processors in Albuquerque, NM are:
- Partnered Staffing
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