Description

You will process and adjust health claims according to established policies and procedures.

Responsibilities

• Process complex claims by applying benefit contracts, pricing, and government regulations.
• Research and analyze claim issues to determine company liability and entitlement.
• Manage coordination of benefits (COB) and healthcare terminology applications.
• Handle grievance and reconsideration processes for various products.
• Respond to inquiries involving direct customer or client contact.

Required Skills

• Minimum 1 year of claims processing experience.
• Working knowledge of HMO, PPO, and COB products.
• Experience with systems analysis and healthcare terminology.
• Proficiency using PC database systems and spreadsheet software.
• Ability to work with minimal guidance on multiple product types.
• Experience with word processing applications.
• Understanding of claims policies, pricing, and processing procedures.

Preferred Skills

• 5+ years of relevant experience.
• 3-year tenure stability in previous roles.

Key Skills

Education

Any Gradute