Screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims.
Determines whether to return, deny or pay claims following organizational policies and procedures.
Reviews processed claims and inquiries to determine corrective action including adjusting claims as necessary.
Responsible for the timely and accurate completion of claims adjustments which could be a result of internal/external audits, member/provider phone calls, other insurance information received, appeals, and system changes.

Senior Claims Processor

About this role