Location
Miami
Job Type
Full-time
Posted
June 04, 2026
Job Description
Job Description
* Analyzes and adjudicates routine claims, determining approval on file, eligibility, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
* Responds to routine phone inquiries and written correspondence related to claim processing issues and/or needs.
* Screens and routes complex claims to claim manager.
* Proofs claim, review, and apply appropriate guideline, coding, member identification, and processes in appropriate turn-around-time.
* Facilitates training in accordance with operational guidelines and manages claims assignment
* Navigates multiple systems to obtain necessary data to adjudicate claims appropriately.
* Ensure payments and/or denials are made in accordance with company practices and procedures.
* Collaborates with customer service team requesting and/or providing feedback and follow up to assist in treatment as well as claims au...
* Analyzes and adjudicates routine claims, determining approval on file, eligibility, identify discrepancies, and applies all cost containment measures to assist in the claim adjudication process.
* Responds to routine phone inquiries and written correspondence related to claim processing issues and/or needs.
* Screens and routes complex claims to claim manager.
* Proofs claim, review, and apply appropriate guideline, coding, member identification, and processes in appropriate turn-around-time.
* Facilitates training in accordance with operational guidelines and manages claims assignment
* Navigates multiple systems to obtain necessary data to adjudicate claims appropriately.
* Ensure payments and/or denials are made in accordance with company practices and procedures.
* Collaborates with customer service team requesting and/or providing feedback and follow up to assist in treatment as well as claims au...