Senior Insurance Claims Adjuster

Job Summary

A company is looking for a Senior Insurance Claims Adjuster.

Key Responsibilities:

• Process a minimum of 1,000 medical, dental, and vision claims per week while maintaining quality goals
• Review, analyze, and make determinations on claims for cost, treatment necessity, and fraud
• Consult with professionals and gather necessary information for claim evaluation

Required Qualifications:

• Minimum of five years of medical claims analysis experience, with recent claims processing experience
• Prior experience with a Third-party Administrator (TPA) is preferred
• Knowledge of CPT and ICD-10 coding
• Strong analytical skills and knowledge of computer systems
• Continuing education in relevant areas affecting group health and welfare plans