The Medical Claims Processor is primarily responsible for accurately and thoroughly processing claims and referrals in a timely manner in accordance with specific plan benefits provisions and guidelines, exclusions and limitations.
Identifies any claims issues and elevates them to the appropriate staff and / or management personnel. Assists with departmental administrative and clerical tasks and efforts.
Essential Functions :
- Accurately and completely processes plan and member claims in a timely manner.
- Identifies any issues or concerns regarding any claims and refers those issues to appropriate Claims Specialists or management personnel.
- Assures claims and claims processing adheres to applicable plan parameters, benefits and guidelines.
- Reviews claims for accuracy and completeness.
- Processes referrals accurately, completely and in a timely manner in accordance with Company and plan guidelines.
- May assist in the research of returned claims and checks.
- Prepares a variety of reports as assigned and required on a daily, weekly and monthly basis, as applicable.
- Cooperatively and supportively works with staff from other departments to ensure accurate and timely processing of claims and referrals.
- Supports department management with special assignments and projects as required and requested.
- Performs any and all additional duties as requested and directed for this position.
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The Medical Claims Processor is primarily responsible for accurately and thoroughly processing claims and referrals in a timely manner in accordance with specific plan benefits provisions and guidelines, exclusions and limitations. Identifies any issues or concerns regarding any claims and refers th...
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