Claim Technician
Core
Process complex healthcare claims requiring investigation, adjudication, and coordination of benefits to ensure timely resolution.
Role type
Claims Technician (Healthcare)
Builds
Accurate claim adjudications and resolved member/provider issues
Domain
Healthcare / Insurance Claims
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical claims processing, data entry, Microsoft Excel, medical terminology, HIPAA compliance, coordination of benefits, claims adjudication, CPT/HCPCS/ICD9 coding
Preferred skills
Blue Chip claims processing system training, multi-tasking, prioritizing
Technologies
Blue Chip, Financial Suspense System (FSS), IMAGE
Responsibilities
Investigate claim discrepancies and resolve denials, contact providers to verify information, coordinate benefits across multiple insurance plans, update patient files with external insurance data, apply coding knowledge to adjudicate claims, maintain knowledge of ERISA and prompt pay legislation
Seniority
Entry-level to Mid-level, hands-on IC
