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All are encouraged to apply! Join Peckham - WORK. GROW. ADVANCE.

Peckham is a nonprofit vocational rehabilitation organization. We specialize in providing vocational rehabilitation and training opportunities for people with significant disabilities, and/or other barriers to employment. If you have a disability or other barrier to employment, please be sure to fully complete the ‘eligibility for services questionnaire’ to help us determine the best fit and necessary accommodations for your employment needs.If you do NOT have a disability, please complete the entire application including the questionnaire. These jobs are open to all abilities but Peckham gives preference to individuals with disabilities.

Peckham Inc. CGS Claims Processor 2

Important Information: Wage: $19.75Shift: First ShiftLocation: Remote in the Winchester, KY area

SUMMARY

The Claims Processor II reviews and adjudicates complex or specialty claims, ensuring compliance with organizational policies and procedures. This role involves entering and verifying claims data, resolving processing errors, and assisting in training or mentoring new staff members. This position involves handling sensitive information and mentoring new staff.

DUTIES AND RESPONSIBILITIES

+ Claims Adjudication (70%): Examine and process complex or specialty claims in accordance with business/contract regulations, internal standards, and examining guidelines. Enter claims into the system after verifying correct coding of procedures and diagnosis codes, ensuring accurate data entry.

+ Quality Assurance (15%): Ensure claims are processed according to established quality and production standards. Correct processing errors by reprocessing, adjusting, or recouping claims as needed.

+ Research and Coordination (15%): Research and resolve claims edits and deferrals using policies, procedures, reference materials, and forms. Coordinate with internal support areas, respond to routine correspondence, and complete spreadsheets as applicable.

+ Report problems that occur and assist with the resolution.

+ Utilize databases and written materials to look up and provide information to telephone inquiries.

+ Maintain appropriate documentation of phone inquiries.

+ Assist with the delivery of internal employee training for new and temporary employees as requested.

+ Follow protocol and apply sensitivity and discretion in handling confidential information.

+ Must be sensitive to cultural diversity and able to work with people from various backgrounds.

+ May be required to work Peckham scheduled holidays. Overtime may be required.

+ Other related duties as assigned.

MINIMUM QUALIFICATIONS

+ At least 18 years old.

+ High School Diploma or equivalent.

+ Proficient in the English language (written and verbal).

+ U.S. Citizen.

+ Ability to pass a thorough background check screening (credit and criminal history) to determine fitness for a federal security clearance.

+ Successfully pass a 10-panel drug screen with a negative result.

+ Experience: 2 years of experience in processing, researching, and adjudicating claims.

+ Strong analytical, organizational, and customer service skills.

+ Excellent oral and written communication skills.

+ Proficient spelling, punctuation, and grammar skills.

+ Good judgment and basic business math skills.

+ Technical Skills: Familiarity with basic office equipment.

+ Proficiency in Microsoft Office

+ Ability to work independently without direct supervision.

+ A neat/quiet room/home office space designated for remote work that meets requirements.

+ A High-Speed Internet connection that meets minimum technical requirements.

PREFERRED QUALIFICATIONS

+ Experience: 5 years of experience in processing and adjudicating claims.

+ Skills and Abilities: Strong time management skills and knowledge of mathematical and statistical concepts.

PHYSICAL DEMANDS

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 functions.

While performing the duties of this job, the individual will be required to multitask. The employee will also be required to speak, listen, read, and use a computer simultaneously during their scheduled shift.

WORK ENVIRONMENT

Individuals will be required to work well independently, however will also be a member of a team and therefore must be able to work in a team atmosphere.  The tasks of the call center are repetitive in nature.  The noise level is generally moderate.  The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Individuals will be on the phone from their remote office for most of their scheduled shift. Peckham will provide a computer, monitor and headset and the employee will provide workspace and internet connectivity that meets minimum requirements.

SECURITY

Many of the positions through the Business Services Division require security clearance. Thus, the candidate/employee must pass and maintain appropriate security and background checks as required for each area and/or contract. The extent of the security and background check may vary by position. Employment may also be contingent upon successful security and background checks and may be run on an ad hoc basis. Required security and clearance checks will be completed at no financial cost to the candidate.

OTHER INFORMATION

This job description in no way states or implies all duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related instructions and to perform other job-related duties requested by their supervisor in compliance with Federal and State Laws.

Peckham is an Equal Opportunity Employer - EEO/AA Employer/Vet/Disabled. Peckham provides equal opportunities and does not unlawfully discriminate on the basis of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, height, weight, marital status, veteran status, or any other protected characteristic protected by applicable federal, state, or local law. EEO is Law (https://dol.gov/ofccp/regs/compliance/posters/ofccpost.htm)

EOE-Embracing Diversity to Achieve Excellence

SPECIAL NOTES

These jobs are part of the AbilityOne program, to learn more about the AbilityOne program go to www.abilityone.gov

PECKHAM IS AN EQUAL OPPORTUNITY EMPLOYER

EEO/AA Employer/Vet/Disabled. Peckham provides equal opportunities and does not unlawfully discriminate on the basis of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, height, weight, marital status, veteran status, or any other protected characteristic protected by applicable federal, state, or local law.

REASONABLE ACCOMMODATION FOR APPLYING NOTICE

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance or a reasonable accommodation to complete any part of your application please:

+ Click HERE (https://www.ilru.org/projects/cil-net/cil-center-and-association-directory) and you will be directed to the ILRU Directory to find an agency in your area that can assist you

+ Click HERE (https://www.careeronestop.org/LocalHelp/AmericanJobCenters/american-job-centers.aspx) and you will be directed to the American Jobs Center (AJC) finder to locate a center near you

+ Email us at [email protected]

+ Call us at (517) 316-4000

+ Visit us at: 3510 Capital City BLVD, Lansing, MI 48906 (M-F 8am - 4pm)

Examples of reasonable accommodations may include making a change to the application process, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Business Line:

Contact Center Solutions

Location:

Home-Based (Kentucky)

Worker Sub-Type:

Team Member