Review & Processes Healthcare payer claims including HCFA & UB forms.
Validate Member, Provider and other Claims information.
Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
Coordination of Claim Benefits based on the Policy & Procedure.
Maintain productivity goals, quality standards and aging timeframes.
Scrutinizing Medical Claim Documents and settlements.
Organizing and completing tasks per assigned priorities.
Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the tea
Resolving complex situations following pre-established guidelines

Requirements for this role include:

University degree or equivalent that required formal studies of the English language and basic Math
3+ Year of experience where you had to apply business rules to varying fact situations and make appropriate decisions
3+ Year...