Claims Verifier

The Claims Verifier is responsible for entering and adjudicating a member's out-patient claims based on received claims documents, provider and health plan contractual agreements, and claims processing guidelines to ensure the proper recording and computation of client/member utilization as well as processing of payment in accordance with the SLAS to our accredited providers, and clients.

Qualifications:

Education:

• Bachelor's degree required, preferably in an Allied Medical Course

Experience (Preferred):

• 1 to 2 years of working experience as a claims processor or in a related role

Work Style:

• Diligent, organized, and highly detail oriented.
• Flexible, proactive, and demonstrates sound judgment.
• Thrives in both independent and collaborative work environments.

Skills:

• Strong analytical, decision-making, comprehension, and problem-solving skills.
• Excellent verbal and written communication skills.
• Proficient in Microsoft Office Suite or similar software programs.
• Possesses knowledge of medical terminologies, illnesses, and coding systems.
• Strong ability to manage multiple tasks and meet deadlines efficiently.