Medical Claims Processor 지역 Description and regulatory turn-around time and quality standards • Reviews claims and makes payment/adjustment determination to ensure all components (i.e. member, provider, authorization, claim, and system) are valid and correct for accurate processing • Conducts research regarding claim completion and appropriateness; identifies errors and takes necessary actions to resolve claims • Manages work to meet regulatory guidelines Responsibilities and Duties • Review claims and makes payment determination • Review and evaluates claims for proper and correct information including correct member, provider, authorization, and billing information on which to base payment determination • Refers to eligibility, authorization, benefit, and pricing information to determine appropriate course of action