Description

You will manage the processing and adjustment of health claims in alignment with established policies and procedures.

Responsibilities

• Process and adjust complex health claims by applying benefit contracts, pricing, and government regulations.
• Research and analyze claim issues to determine company liability and entitlement.
• Manage grievance and reconsideration processes for various products.
• Respond to inquiries involving direct customer or client contact.
• Analyze claim-related events to ensure accuracy in processing.

Required Skills

• Minimum of 1 year of claims processing experience.
• Practical knowledge of HMO, PPO, and COB.
• Understanding of healthcare terminology and coordination of benefits.
• Experience using database systems, word processing, and spreadsheets.
• Ability to work with minimal guidance on multiple product types.
• Proficiency in researching and resolving complex claim discrepancies.
• Knowledge of claims policies, procedures, and government regulations.

Key Skills

Education

ANY GRADUATE