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