Claims Processor

Responsibilities:
➢ Review and analyze healthcare claims for accuracy, completeness, and adherence to contractual agreements and regulatory guidelines.
➢ Verify member eligibility and benefits coverage for submitted claims.
➢ Evaluate medical documentation to assess the appropriateness of services rendered and coding accuracy.
➢ Adjudicate claims accurately and efficiently within established turnaround times.
➢ Identify and investigate potential fraudulent or abusive billing practices.
➢ Communicate claim decisions, payment details, and denials to providers and members effectively.
➢ Collaborate with other departments, such as Provider Relations and Customer Service, to resolve claim-related issues and inquiries.
➢ Maintain comprehensive and organized claim records, documentation.

Work Schedule: Mon-Fri 8:30am-5:30pm
Salary Offer: 16, 000