Claims Processor

Summary

Responsible for accurate review, input and adjudication of Provider claims in accordance with outside regulation, internal production standards and contractual obligations of the organization.

Duties and Responsibilities

  • Accurately review all incoming Provider claims to verify necessary information is available.
  • Accurately enter claims data information into the computerized claims adjudication system
  • Maintain all required documentation of claims processed and claims on hand
  • Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
  • Maintain production standards established by claims management.
  • Coordinate resolution of claims issues with other departments or payers.
  • Assist other departments in claims research
  • Provide backup for other examiners within the department.
  • Promote a spirit of cooperation and understanding among all personnel
  • Attend organizational meetings as required
  • Adhere to organization policies and procedures

Minimum Job Requirements

High school diploma.

Knowledge, Skills and Abilities Required

  • Strong organizational skills.
  • Knowledge of computers
  • Ability to be flexible in high volume setting

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