Claims Processing Professional

Review and process healthcare claims within established turnaround times by verifying member eligibility, provider information, authorizations, and contractual requirements. Determine appropriate outcomes to approve, deny, adjust, or return claims while resolving discrepancies through supporting documentation. Process both electronic and paper claims using internal systems to maintain productivity, quality, and accuracy standards in compliance with HIPAA regulations and organizational policies. Collaborate with internal departments to resolve claim issues and support claim adjudication while adapting to evolving business processes and regulatory changes.