Review and enter claim information data from the claim form into the computer system.
Review and correct claim data fields as appropriate and necessary. Review and defer claims requiring additional research. Meet quality, accuracy and turn-around standards for claims by verifying and entering the correct information daily.
Adjudicate medium complexity medical claims such as fee for service, in timely and accurate manner. Consistently and accurately adjudicate all complex contracted claims with fee-for-service carve outs, professional and hospital claims for non-contracted provider and contracted hospital claims for both Commercial and Senior plans within the timeliness and accuracy standards set forth by CMS, Department of Managed Care, AB1455 and the Claims Department policies and procedures.