Claims Processor

A company is looking for a Claims Processor to review and determine the payment status of medical and dental claims.

Key Responsibilities

Process a minimum of 1,200 medical, dental, and vision claims weekly while ensuring compliance with clients' customized plans

Independently analyze claims for cost reasonableness, unnecessary treatments, and potential fraud

Document and finalize claim determinations in a timely manner, supporting other Claims Specialists as needed

Required Qualifications

High School Graduate or equivalent required

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

Knowledge of CPT and ICD-10 coding is necessary

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

Experience with dental and vision processing is preferred but not required