Medical Claims Sr. Associate

Overview

PURPOSE 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.

Role Description

PURPOSE 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 edi...