Claims Specialist

Job Summary

A company is looking for a Claims Specialist to review and analyze medical, vision, and dental claims.

Key Responsibilities

• Review, analyze, and determine payment outcomes for claims based on client plans
• Request and evaluate additional information from claimants and healthcare providers
• Document findings and process claims in the QicLink System

Required Qualifications

• High School Diploma required; college education preferred
• Minimum of five years of medical claims analysis and adjudication experience
• Strong analytical skills and knowledge of CPT and ICD-10 coding terminology
• Continuing education in areas affecting group health and welfare plans is required
• Prior experience in Adjustment Processing is preferred but not required