Claims Reviewer
A company is looking for a Claims Reviewer to evaluate medical claims and ensure compliance with established guidelines. Key Responsibilities Conducts medical claims review to assess medical necessity and appropriateness of care Validates medical determinations through research and prepares cases for further review Identifies process improvements and ensures compliance with contract timelines for claims resolution Required Qualifications High School Diploma or GED 2+ years of claims review experience Knowledge of all types of medical claims review
A company is looking for a Claims Reviewer to evaluate medical claims and ensure compliance with established guidelines.
Key Responsibilities
Conducts medical claims review to assess medical necessity and appropriateness of care
Validates medical determinations through research and prepares cases for further review
Identifies process improvements and ensures compliance with contract timelines for claims resolution
Required Qualifications
High School Diploma or GED
2+ years of claims review experience
Knowledge of all types of medical claims review
