Claims Processor I

Determine covered medical insurance benefits in accordance with the provisions of the plan document. Document medical claims processes by completing forms, reports, logs and records. Resolve medical claims by approving or denying, calculating benefit due and initiating payment or denial. Ensure legal compliance by following company policies, procedures, guidelines, as well as federal insurance regulations.

Accurate and timely resolution of Epic PB and nThrive edits. Resolve rejections related to EDI based on carrier/departmental guidelines. Access applicable websites and VRU to verify effective/term date. Add indicated insurance to accounts/visits. Timely preparation of claims reviewing for accuracy for both primary and secondary, alerting management of any issues. Retrieval of required documentation from applicable system. If not retrievable, follow department guidelines for holding claim. Accurate notation of action taken in appropriate application per departmental guidelines.

Minimum Education and Experience: 

Education: High School Degree or Equivalent Work Experience: 0-6months