Claims Processing Executive

Immediate need for a talented Claims Processing Executive. This is a 06+months contract opportunity with long-term potential and is located in IOWA(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 26-22885

Pay Range: $19/hr - $20/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Claims Processing: Review, validate, and process healthcare claims submitted by providers in accordance with US insurance policies.
• Core platform QNXT claims experienced - Preferred
• MUST HAVE CLAIMS and FACETS experience
• Eligibility Verification: Confirm patient coverage, benefits, and pre-authorization requirements under Medicare, Medicaid, and private insurance plans.
• Adjudication: Approve, deny, or adjust claims based on payer guidelines and policy terms.
• Compliance: Maintain adherence to HIPAA regulations, CMS guidelines, and other US healthcare compliance standards.
• Documentation: Record claim activity, maintain audit trails, and prepare reports for management.

Key Requirements and Technology Experience:

• High school diploma or equivalent REQUIRED
• Strong knowledge of US healthcare insurance systems (Medicare, Medicaid, commercial payers).
• 2 4 years of experience in US healthcare claims processing
• Familiarity with claims management software and EDI transactions.
• Excellent analytical, organizational, and communication skills.
• Ability to interpret insurance policies and payer guidelines.
• Detail-oriented with strong problem-solving abilities.
• Competencies-
• Regulatory Knowledge Deep understanding of US healthcare laws and payer requirements.
• Accuracy & Detail Orientation Ensures claims are processed correctly and efficiently.
• Problem-Solving Resolves claim disputes and denials effectively."

Our client is a leading IT Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .