The Claims Analyst position responsible for processing medical, dental and vision claims.
Review and process medical claims according to Plan guidelines within established turnaround time frames
Interpret medical plan to assure system is coded correctly
Review claims for legitimacy and accuracy
Meet production and quality standards set for examiners
Work Customer Service inquiries related to claim questions
Review correspondence submitted by members and providers and adjust all related claims if the additional documentation submitted warrants adjustment
Other duties as assigned
High School/GED required
Demonstrate skills in problem solving and benefit plan interpretation
Knowledge of CPT codes, ICD10 codes and/or medical terminology is a plus
Ability to work independently
PC proficiency
Average typing ability