Claims Processor

Job Summary

A company is looking for a Claims Processor to review and analyze medical and dental claims.

Key Responsibilities

• Process a minimum of 1,200 medical, dental, and vision claims per week while maintaining quality goals
• Independently review, analyze, and make determinations on claims regarding cost reasonableness, unnecessary treatment, and fraud
• Authorize payment, partial payment, or denial of claims based on individual investigation and analysis

Required Qualifications

• High School Graduate or equivalent required
• Minimum of two (2) years of medical claims analysis experience required
• Prior experience with a Third-party Administrator (TPA) is highly preferred
• Knowledge of CPT and ICD-10 coding is required
• Strong analytical skills and knowledge of computer systems are essential