Claims Processor I

POSITION PURPOSEResearches and verifies complex claims information to ensure the accurate and timely processing of claims. Enters all information needed to process claim. Identifies inconsistencies and makes necessary corrections. Accountable for complying with all laws and regulations associated with duties and responsibilities.NATURE AND SCOPEThis role does not manage peopleThis role reports to this job: SUPERVISOR, CLAIMS OPERATIONSNecessary Contacts: In order to effectively fulfill this position, the Claims Processor I must be in contact with: Various internal departments and staff including, but not limited to, Provider Services, Legal, Internal Audit, IT, other Benefits Operations Management and staff, Membership and Billing, Administrative Services, and District Offices. Various external entities including, but not not limited to, Providers, Members, Lawyers, Groups, Commissioner of Insurance, other insurance companies, and other Plans.QUALIFICATIONSEducationHigh School Diploma