Claims Processor

Job Summary

A company is looking for a Claims Processor to review and determine the payment status of medical and dental claims.

Key Responsibilities

• Process a minimum of 1,200 medical, dental, and vision claims weekly while ensuring compliance with clients' customized plans
• Independently analyze claims for cost reasonableness, unnecessary treatments, and potential fraud
• Document and finalize claim determinations in a timely manner, supporting other Claims Specialists as needed

Required Qualifications

• High School Graduate or equivalent required
• Minimum of two (2) years of medical claims analysis experience required
• Knowledge of CPT and ICD-10 coding is necessary
• Prior experience with a Third-party Administrator (TPA) is highly preferred
• Experience with dental and vision processing is preferred but not required