Claims Processor

A company is looking for a Claims Processor to review and analyze medical and dental claims.

Key Responsibilities

Process a minimum of 1,200 medical, dental, and vision claims per week while maintaining quality goals

Independently review, analyze, and make determinations on claims regarding cost reasonableness, unnecessary treatment, and fraud

Authorize payment, partial payment, or denial of claims based on individual investigation and analysis

Required Qualifications

High School Graduate or equivalent required

Minimum of two (2) years of medical claims analysis experience required

Prior experience with a Third-party Administrator (TPA) is highly preferred

Knowledge of CPT and ICD-10 coding is required

Strong analytical skills and knowledge of computer systems are essential