Claims Reviewer

Job Summary

A company is looking for a Claims Reviewer to evaluate medical claims and ensure compliance with established guidelines.

Key Responsibilities

• Conducts medical claims review to assess medical necessity and appropriateness of care
• Validates medical determinations through research and prepares cases for further review
• Identifies process improvements and ensures compliance with contract timelines for claims resolution

Required Qualifications

• High School Diploma or GED
• 2+ years of claims review experience
• Knowledge of all types of medical claims review