HDSI: Claim Processor

Job Overview: The Claim  Processor is responsible for timely processing of medical claims based on the member's health benefit program. They analyze medical information, perform data entry, handle reimbursement claims, and decide whether a claim should be covered or denied. Communicate issues or exceptions to other concerned departments as necessary.
This role will be hired under Flexicare, Health Delivery System, Inc. (HDSI)—a subsidiary of RelianceUnited for a 4-month fixed-term contract.
Duties and Responsibilities:

• Process claims by reviewing, researching, investigating, and adjudicating claims.
• Authorize the appropriate payment or refer/escalate claims to concerned parties for further review.
• Adjudicate claims, analyze validity, identify trends, and provide reports if necessary.
• Communicate any discrepancy of claims.
• Consistently meets established productivity, schedule adherence, and quality standards. Suggest any process imp...