Senior Claims Examiner

POSITION SUMMARY/RESPONSIBILITIES
Performs review, analysis, and adjudication of all claim types, including coordination of benefits and DME claims. Performs analysis of provider appeals and documents outcome determination via correspondence. Acts as a provider liaison for claim issue resolution by utilization of appropriate corporate functionalities.

EDUCATION/EXPERIENCE
High school diploma or GED equivalent required. Five (5) years' HMO, PPO, ASO claim processing experience is required. Thorough knowledge of medical terminology, ICD-9/CPT4 Coding, and general managed care principles is required.