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1

claims processor

  • Demonstrates telephone customer service skills and empathizes with customers and claimants.
  • Organizes and prioritizes work to assure accuracy and productivity targets are met.
  • Effectively works independently and as a team.
  • Documents and preserves all verbal and written communication in the claims system.
  • Establishes and maintains accurate loss and expense reserves.
  • Conducts investigation into claims.
  • Submits payments to vendors weekly and properly controls claims expenses.
2

claims processor

  • Investigation and proccesing of claims
  • Recommends Approval/Rejection of claims
  • Develop company-client favorable business relationship
  • Processed and audited manual paper claims for Workers Compensation clients
3

claims processor

  • Process medical claims for the sate of TN, FL, LA, KS
  • Use citrx and Facets 
  • Production 122-160 day 
  • Reached out to pharmacies to verify missing required information to process claims
4

claims processor / collection specialist

  • Processed professional (1500) and facility (UB04) claim reimbursement according to managed care contracts
  • Contacted payers to follow-up on claim and payment status
  • Maintains compliance with applicable Department of Insurance regulations.
  • Keeps direct supervisor informed of significant developments in all assigned claims.
5

claims processor

  • Reviewed and processed medical claims and collected information as needed to insure swift and accurate payments to providers 
  • Responds to any inquiries from Brokers/Agents, insureds, claimants, attorneys, outside business partners and internal staff in a timely, thorough and accurate manner.
  • Assign claims, pay vendors, process payments and denials.
  • Responds to insureds requests, questions, and review estimates

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