Claims Processor

Job Summary

A company is looking for a Medical Claims Processor.

Key Responsibilities:

• Process Medical and Dental claims as well as invoices in the QicLink system
• Review, analyze, and make determinations of claims for reasonableness of cost, unnecessary treatment, and fraud
• Authorize payment, partial payment, or denial of claims based on individual investigation

Required Qualifications:

• High School Graduate or equivalent
• Minimum of two years of medical claims analysis experience
• Prior experience with a Third-party Administrator is preferred
• Knowledge of CPT and ICD-10 coding
• Continuing education in all areas affecting group health and welfare plans