Review, investigate, and verify coverage to ensure proper processing of medical claims
Process complex claim scenarios per SPDs (COB, Prior Authorization, HRA, Transplant, High Dollar)
Review queues and address nuances with appropriate parties
Be a go-to resource for Examiners; assist with training and special projects
Support leadership with inventory, process development, and auditing

🎯 Requirements

High School Diploma
4+ years processing/adjusting/analyzing medical claims (TPA environment preferred)
Strong CPT/HCPCS and ICD-10 knowledge
Prioritize, manage time, and work independently
Comfort with Zoom, Microsoft Teams, or Google Meet
CMS claims submission regulations knowledge

🎁 Benefits

Comprehensive benefits package
Flexible PTO; up to 16 weeks paid parental leave
Paid holidays; 401k program
Transportation perks; education reimbursement
2 days paid paw-ternity leave

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