Claims Processor

It is the policy of Quality Care for Children that all employees shall receive an equal employment opportunity without regards to race, color, religion, veteran status, sex, national origin, age, marital status or disability in employment. 

COVID-19 Vaccination Requirement:  you must be fully vaccinated including Booster for COVID-19 by date of hire to be considered for position. 

Claims Processor

Department: Nutrition and Family Well-Being 

Supervisor: Claims and Applicant Services Manager 

Salary: $38,000 - $42,999 

POSITION SUMMARY 

The Claims Processor is responsible for the review, adjustment and compliance monitoring of document submissions made by operators of a federal-funded meal program for children. The processor works directly with directors and owners of child care facilities and conducts monthly desk audits prior to the issuance of reimbursement to each site. An ideal candidate must be detailed oriented, organized and able to multitask. Additionally, the claims processor must be very communicative by calls, teleconferencing and emails while maintaining superb customer service skills and actively listening. The position entails the use of a well-known industry software (KidKare), Microsoft Office (Excel, Word, Outlook), Citrix and other platforms.  

RESPONSIBILITIES 

Claims processing and Offsite Monitoring for Compliance (50%) 

• Use independent judgment to determine if sites are complying federal regulations and program guidelines 
• Make recommendations for noncompliance determinations using evidence from offsite monitoring in conjunction with site monitoring reviews conducted by Nutrition Program Consultants (monitors) 
• Coordinate claim processing with child care centers 
• Reconcile expense and enrollment documentation and discern the credibility of evidence provided by the center. 
• Make claim adjustments during the reconciliation process 
• Coordinate claims processing with staff 
• Review claim reports relevant to monthly claims 
• Create claim file to disseminate to each site (centers only)  

Eligibility verification (20%) 

• Verify IES forms and enrollments forms  
• Verify tier status for five-year tiered FCC providers 

Maintenance of records and database (10%) 

• Maintain adequate records in database and physical file 
• Update provider file with any new changes 

Monitoring, Technical Assistance and Training (15%) 

• Conduct onsite monitoring visits with Nutrition Program Consultants 
• Conduct onsite follow-up monitoring visits 
• Examine site monitoring reviews for accuracy  
• Offer phone technical assistance as needed 
• Provide technical assistance to centers and homes 
• Conduct Child and Adult Care Food Program orientation and other training as needed 

Administrative (5%)

• Parental/household contacts for attendance and enrollment verification 

REQUIREMENTS 

• Minimum three (3) years of relevant work experience 
• Bachelor’s degree is required but a degree in a related field is preferred 
• Good knowledge of child care standards and practices 
• Skilled customer service 
• Strong organizational skills, interpersonal skills, and communication skills (written and oral) 
• Proficient in Word, Excel, PowerPoint and Outlook 
• Valid driver’s license and personal transportation required 
• Available to work occasional nights and weekends 
• Team player 
• Self-directed with the ability to work independently 

PHYSICAL DEMANDS/WORK ENVIRONMENT 

• Occasional driving 
• Consistently standing for two hours or more delivering training 
• Sitting at the computer for three hours or more at a time 
• Bending, frequent use of hands, stooping and moderate lifting (at least 25 pounds) required 
• Noise level in the work environment may be high at times. 

ADDITIONAL INFORMATION: Quality Care for Children's Atlanta office is the base location for this position with flexibility for home-based work. 

To Apply 

Please e-mail HR@qccga[dot]org your resume and 1-page cover letter (list applied position in the e-mail's subject line). Please include your name when titling email attachments.  

Resumes will be accepted until the position is filled.  No phone calls please.