Senior Claims Representative
Job Summary
A company is looking for a Claims Representative Senior to perform complex claims research and resolution.
Key Responsibilities
- Conduct extensive research and analysis of claims to resolve disputes
- Support Customer Service and address provider disputes and appeals
- Prepare reports for management on trends and quality improvement recommendations
Required Qualifications
- High School Diploma or GED
- 3+ years of claims adjudication experience
- Knowledge of various lines of business including Commercial, Medi-Cal, and Medicare
- 4+ years of medical claims knowledge
- Understanding of healthcare regulations and compliance related to AB1455
COMPLETE JOB DESCRIPTION
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