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SPS Claims Processor Job – Fresno, CA 45024

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Why You'll Love This Job

This position requires the ability to process claims in a data entry type environment, while maintaining the correct benefit structure based on the type of dental and vision plan of the client. Requires a high level of detail to the different processes of the different types of plans we administer. The position requires processing requirements of 120 claims per day on average with 95% payment accuracy.

This position has the option of working remotely from home or an outside office. Before this position becomes remote, the person must meet the requirements set below for home processing.

Responsibilities

  • Data entry of all dental claims.
  • Adjudication of dental claims based on certain types of dental plans.
  • Identify and handle specialized claims by group.
  • Identify problem areas, problem claims or issues with systems and incorrect benefit calculations.
  • Cross train as requested on dental and vision claims.
  • Repricing of certain claims as required by plan set up.
  • Identify system errors and correct errors.

Skills & Qualifications

  • Basic computer skills and knowledge of Microsoft Word, Excel, and Outlook
  • Good written and verbal communications skills
  • Good attendance
  • Good work attitude, adaptability, and multi-tasking abilities
  • Independent/self-motivated and ability to work in team environment.
  • Willingness to work outside scheduled work hours as needed, especially during our busy season.
  • Attention to detail.
  • Good organizational skills
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