Claims Review Representative 3

Job Title: Claims Review Representative

Location: Remote

Duration: 7 Months



The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation.



The Claims Review Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. The Claims Review Representative 3 partners with professional staff on pre-screening review by applying guidance and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.



Required Qualifications

1 - 3 years of technical experience

Less than 2 years of Professional leadership experience

Strong and proven experience with processing and adjudicating medical claims

Proficiency in Microsoft Office applications including Word, Excel and Outlook

Working knowledge of computers or a demonstrated technical aptitude

Ability to quickly learn new systems

Ability to manage and prioritize tasks based on business need

Must be passionate about contributing to an organization focused on continuously improving consumer experiences



Preferred Qualifications

Associate or bachelor's Degree

Knowledge with CPT and ICD9 terminology/codes

CAS and/or CCP experience

CIS/ CIS Pro experience