Licensed Medical Claims Processor

Job Summary

To support the World Trade Center Health Program, the full-time Licensed Medical Claims Processor will analyze and process complex medical claims while ensuring accuracy, compliance, and timely resolution of discrepancies in a fully remote environment.

Key responsibilities:

• Analyze and process a variety of complex medical claims in accordance with program policies and procedures
• Proactively resolve claim discrepancies and collaborate with other departments to implement solutions
• Maintain thorough records of claims processed and participate in audits to ensure compliance with regulations

Required qualifications:

• High school diploma or equivalent
• Minimum of 5 years' experience in medical claims processing, including complex and high-dollar claims
• Familiarity with ICD-10, CPT, and HCPCS coding systems
• Understanding of medical terminology and healthcare insurance procedures
• Experience with claim denial resolution and the appeals process