Claims Specialist - Mission Viejo California

Company: VirtualVocations
Location: Mission Viejo, California
Posted On: 11/15/2024

A company is looking for a Claims Specialist I to resolve medical claims that are not automatically adjudicated.



Key Responsibilities

Process and resolve pended claims, including data entry and benefit eligibility determination
Conduct investigations and communicate with internal staff and medical providers to obtain necessary information
Maintain knowledge of processing procedures and stay current with changes in benefits and systems


Required Qualifications

High School diploma or equivalent
Minimum two years of college coursework in a related field or one year of relevant office experience
Must pass company proficiency test: Claims Assessment
Knowledge of anatomy, medical terminology, and related subjects is preferred
Must adhere to security and confidentiality standards as outlined in company policies More...

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