Medical Claims Processor
Current1. Enters claims data into system while interpreting coding and understanding medical terminology in relation to diagnosis and procedures.2. Review, analyze, and resolve claims through the utilization of available resources for moderately complex claims.3. Analyze and apply plan concepts to claims that include; deductible, coinsurance, copay, out of pocket, etc.4. Examines claims to determine if further investigation is needed from other departments and routes claims appropriately through the system.5. Adjudication of claims to achieve quality and production standards applicable to this position.6. Release claims by deadline to meet company, state regulations, contractual agreements and group performance guarantee standards.7. Reviews User Procedure Manuals (UPMs) for process instructions to ensure accurate and efficient claims processing as well as providing suggestions for potential process improvements.8. Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, state and departmental confidentiality guidelines.