Medical Claims Sr. Associate

Responsible for ensuring the accurate processing and completion of medical claims in accordance with established guidelines and policies. The associate is expected to demonstrate proficiency in applicable product lines within the processing unit.

Responsibilities

• Process new claims or modify existing claims as required, adhering to appropriate actions and organizational standards
• Analyze submitted claims to determine whether approval or denial of payment is warranted
• Identify accurate payment criteria to resolve pending claims based on established policies and procedures
• Conduct research on claim edits to determine proper benefit application utilizing set criteria, and apply physician contract pricing for entry-level claims as necessary
• Review and address provider inquiries related to claim adjudication
• Apply knowledge of medical coding (if applicable) and various medical claims forms throughout the claims ...