Key Responsibilities

• Responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. 
• Works without significant guidance w/ basic understanding of multiple products (HMO, PPO, COB, etc.).
• Able to handle more complex claim with a good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regs, coordination of benefits,& healthcare terminology.
• Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement.
• Researches and analyzes claims issues.
• Responds to inquiries, may involve customer/client contact. 

Required Qualifications

• Minimum of 2 year of claims processing experience.
• Experience using PC, database system, and related software (word processing, spreadsheets, etc.)
• Education and experience which would provide an equivalent background.
• Good working knowledge of claims and products, including the grievance and/or re-consideration process.
• Excellent knowledge of the various operations of the organization, products, and services.

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