The Medical Claims Processor is primarily responsible for accurately and thoroughly processing claims and referrals in a timely manner in accordance with specific plan benefits provisions and guidelines, exclusions and limitations. Identifies any claims issues and elevates them to the appropriate staff and/or management personnel. Assists with departmental administrative and clerical tasks and efforts.
Essential Functions
Accurately and completely processes plan and member claims in a timely manner.
Identifies any issues or concerns regarding any claims and refers those issues to appropriate Claims Specialists or management personnel.
Assures claims and claims processing adheres to applicable plan parameters, benefits and guidelines.
Reviews claims for accuracy and completeness.
Processes referrals accurately, completely and in a timely manner in accordance with Company and plan guidelines.
May assist in the research of returned claims and checks.
Prepares a variety of reports as assigned and required on a daily, weekly and monthly basis, as applicable.
Cooperatively and supportively works with staff from other departments to ensure accurate and timely processing of claims and referrals.
Supports department management with special assignments and projects as required and requested.
Performs any and all additional duties as requested and directed for this position.
Requirements
Medical Claims
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Staffing and Recruiting
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