-Analyzes and adjudicates routine claims, determining approval on file, eligibility, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
-Responds to routine phone inquiries and written correspondence related to claim processing issues and/or needs.
-Screens and routes complex claims to claim manager.
-Proofs claim, review and apply appropriate guideline, coding, member identification, and processes in appropriate turn-around-time.
-Facilitates training in accordance with operational guidelines and manages claims assignment
-Navigates multiple systems to obtain necessary data to adjudicate claims appropriately.
-Ensure payments and/or denials are made in accordance with company practices and procedures.
-Collaborates with customer service team requesting and/or providing feedback and follow up to assist in treatment as well as claims authorization.
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-High school diploma/GED required
-2+ years of experience as a medical claims processor in a health insurance or related field company
-Strong analytical, detail-oriented and accuracy skills are required
-Ability to manage time effectively, set priorities, meet deadlines as well as adapt to change
-Desire to work in a small entrepreneurial environment
-Healthcare related insurance experience is a significant plus