Claims Processor

We are seeking a highly skilled and detail-oriented Claims Processor to join our team.

• Process and verify claims information, including personal details, provider information, invoices, and procedure codes
• Validate data entered by colleagues to ensure accuracy and completeness
• Select the most appropriate pre-authorization for each claim
• Identify duplicate claims and take prompt action to resolve them
• Review and respond to alerts related to members and providers in a timely manner
• Refer cases to the calling team for further investigation as needed
• Manage policy and non-policy messages with care and attention to detail
• Analyze and investigate policy messages using various tools, including support points and information sites
• Refer cases to relevant departments, such as HCS, TMT, and Triage, after adjudication
• Identify front-end savings opportunities by investigating claims to prevent overcharging, ineligible charges, contract non-compliance, provider or member fraud