Jobs in the United States

21 jobs

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Added 22 hours ago
ADMINISTRATIVE ASSISTANT II - 79000923
State of Florida
TAMPA, FL
…will also work directly with law enforcement officers as a processor of criminal and administrative cases. You will also be required to digitally upload license applications taken from the…
Added 2 days ago
AN
HR ASST (MIL) (Title 32) (Indefinite)
Army National Guard Units
Richmond, VA
- $52,710 to $68,524 USD / year
Serves as a final reviewer and/or processor of actions, which may include but are not limited to: accessions, discharges/separations, promotions, awards, reductions, transfers, boards,…
Added 4 days ago
KT
Billing Specialist II Hybrid
Klamath Tribal Health & Family Services
Klamath Falls, OR
- $41,892 to $73,459 USD / year
…encounter forms, posting charges into the computer system, perform claims review, claims submission, timely billing, follow-up and collection of all accounts, payment posting, claims audit…
Added 5 days ago
AN
HR ASST (MIL) (Title 32) (Indefinite)
Army National Guard Units
Richmond, VA
- $52,710 to $68,524 USD / year
Serves as a final reviewer and/or processor of actions, which may include but are not limited to: accessions, discharges/separations, promotions, awards, reductions, transfers, boards,…
Added 8 days ago
Medical Payments Processor II
Pinnacol Assurance
CO · Denver, CO
Six months in medical claims processing required.
Added 10 days ago
Claims Processor II (Remote)
CareFirst
Baltimore, MD
Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to…
Added 10 days ago
Claims Processor II
Magellan HRSC, Inc.
United States
Responsible and accountable for the accurate and timely processing of all claims. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy…
Added 10 days ago
Processor, Claims II
CGS Administrators, LLC
Nashville, TN
Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new…
Added 11 days ago
Financial Crimes Analyst II
Orion Financial
Memphis, TN
Handle end-to-end transaction error processing in alignment with internal policies, processor rules, and regulatory requirements.
Added 13 days ago
Claims Processor II
Kaiser Permanente
Renton, WA
Under direction supervision, this position is responsible for the adjudication of post service claims including all edits and financial calculations for payment to providers or members.
Added 15 days ago
ADMINISTRATIVE ASSISTANT II - 79000205
MyFlorida
FORT MYERS, FL
…will also work directly with law enforcement officers as a processor of criminal and administrative cases. You will also be required to digitally upload license applications taken from the…
Added 18 days ago
EFT Processor II
Northwest Bank
Columbus, OH
Added 19 days ago
T
Claims Processor
TEKsystems
Milwaukee, WI
- $19.25 USD / hour
DescriptionJob DescriptionWe are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay…
Added 19 days ago
T
Claims Processor
TEKsystems
Appleton, WI
- $19.25 USD / hour
We are seeking a detail-oriented Claims Analyst II to join our healthcare claims team. In this role, you will be responsible for reviewing, analyzing, and adjudicating medical claims while…
Added 21 days ago
EFT Processor II
Northwest Bank
Columbus, OH
The EFT Processor II will be responsible for processing EFT Cardholder Disputes, assisting Contact Center and branches through e-mail and phone, respond to FISERV requests, process EFT…
Added 23 days ago
HS
School Administrative Services Assistant I, II, III - Ke Kula `O `Ehunuikaimalino
Hawaii State Department of Education
Kealakekua, HI
- $4,040 to $4,730 USD / month
Skilled Typing Requirement: Applicants must be able to type accurately (using a typewriter or word processor) from plain or corrected copy at the rate of 40 net words per minute.
Added 27 days ago
Claims & Referral Processor
SA Technologies Inc.
Aurora, CO
Description: Title: Claims & Referral Processor II
Added 27 days ago
Fin Ops Recovery Spec II
Mindlance
Eagan, MN
SKILLS: Claims Processor, Claims experience , Data entry, Healthcare
Added 28 days ago
Claims Processor II
MUSC Community Physicians (MCP)
Remote, United States
…encourage collaboration among groups. Collaborates with other claims processor II, to review and enhance existing workflows supporting training PPA team…
Added 28 days ago
Mortgage Servicing & Loan Origination Manager
MCI Careers
Savannah, GA
…least 30 loans closed, plus additional experience as a mortgage processor, underwriter, manager or instructor;…
Added 28 days ago
Finance and Accounting
MCI Careers
UNAVAILABLE
Reconcile processor reports, collections, bank statements, and client payable balances.

No more jobs.

CareFirst

Claims Processor II (Remote)

Baltimore, MD, United States

Salary Range: $36,720 - $67,320

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Job details

Pay: Salary Range: $36,720 - $67,320
Experience: Experience: 3 years claims experience required.
Posting language: English
Posted: Oct 29, 2026

Original job description

Resp & Qualifications

PURPOSE:

Under general supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.

ESSENTIAL FUNCTIONS:

Examines and resolves non-adjudicated claims to identify key elements of processing requirements based on contracts, policies and procedures. Process product or system-specific claims to ensure timely payments are generated and calculate deductibles and maximums as well as research and resolve pending claims. The Claims Processor also use automated system processes to send pending claims to ensure accurate completion according to medical policy, contracts, policies and procedures allowing timely considerations to be generated using multiple systems.
Does extensive research of procedures. May also apply training materials, emails and medical policy to ensure claims are processed correctly. Utilizes the quality team for assistance on unclear procedures and/or difficult claims and receives coaching from leadership. Ongoing developmental training to performing daily functions.
Completes productivity data daily that is used by leadership to compile performance statistics. Reports are used by management to plan for scheduling, quality improvement initiatives, workflow design, financial planning, etc.
Assists Customer Service Reps by providing feedback and resolving issues and answering basic processing questions.

QUALIFICATIONS:

Education Level: High School Diploma or GED.

Experience: 3 years claims experience required.

Preferred Qualifications:

3 years claims processing, billing or medical terminology experience.

Knowledge, Skills and Abilities (KSAs)

Demonstrated communication skills both written and verbal.
Demonstrated strong analytical skills.
Demonstrated knowledge and understanding of claims systems and processes.
Demonstrated reading comprehension of materials provided to adjudicate claims.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $36,720 - $67,320

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

OPM HMO

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

REQNUMBER: 22649

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