Principal Claims Policy Expert
VirtualVocationsPort Saint Lucie, Florida, United Statesjob_description.job_card.variable_days_ago
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- serp_jobs.job_card.full_time
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A company is looking for a Principal Claims & Payments Expert to serve as a lead authority on claims-related policy matters.
Key Responsibilities
Interface directly with providers on claims policies and disputes
Lead the Payment Policy Committee and provide policy recommendations
Review provider contracts for compliance and operational feasibility
Make adjudication decisions on complex claims and set policy precedents
Required Qualifications
10+ years of claims expertise in U.S. healthcare and Medicare Advantage
Extensive experience in claims policy and adjudication at a large-scale payer
Strong functional expertise in Medicare Advantage health plan operations
Expertise in medical coding (CPT, HCPCS Level II, ICD 10 CM / PCS)
Proficiency with technology and AI tools for claims and policy analysis
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Claim • Port Saint Lucie, Florida, United States
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