Claims Representative
Core
Process Supplemental Health claims to adjudicate benefits for customers experiencing accidents, illnesses, and hospital stays.
Role type
Claims Representative (IC)
Builds
Supplemental Health claims adjudication decisions
Domain
Health Insurance / Claims Processing
Required skills
CPT/ICD-10 code knowledge, policy interpretation, eligibility verification, Microsoft Office proficiency, multi-application navigation, data accuracy
Preferred skills
Health insurance claims processing experience, customer service experience
Technologies
eMOS, Outlook, Teams, WebEx, Cognos, Ring Master, SAM3
Responsibilities
Review claim submissions and verify documentation, adjudicate claims based on policy provisions, manage pending claims inventory, maintain quality and productivity KPIs, work independently in a virtual environment
Seniority
Entry-level to Mid-level, hands-on IC
