Claims Processor

  • Location: Tampa, Florida
  • Type: Direct Hire
  • Job #10147

Position Summary:

The Claims Processor will provide timely and accurate processing and adjudication of claims for a third party administrator. The role will research, and process claims for covered members across various products including medical, pharmacy, vision and related healthcare options.    

Responsibilities:

  • Work from a queue to review assigned claims at a set inventory level.
  • Examine claims to identify key elements and processing requirements based on diagnosis, provider, medical policy, contract and/or policy. 
  • Efficiently and accurately analyze medical claims to determine whether or not the claim should be approved or denied for payment in accord with the plan / client conditions.
  • Resolve pended healthcare claims and prior approval requests.
  • Review and address provider inquiries regarding claim adjudication.
  • Assist Customer Service Representative by providing feedback and resolving issues related to claims processing inquires.
  • Meet performance and quality metrics.

Qualifications:

  • High School Diploma or equivalent.
  • 2 years of medical claims processing including knowledge of medical terminology and working in a production environment.
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