TL-Claims HC

Job Summary This hybrid night shift role focuses on adjudicating complex health care claims while ensuring strict adherence to HIPAA regulations and alignment with payer and provider rules. The professional will handle end to end claims review resolve discrepancies and collaborate with cross functional teams to improve claims accuracy and cycle times helping the company deliver fair and timely outcomes for members and health care partners. Responsibilities Manage end to end claims adjudication for health care claims by applying policy guidelines payer rules and provider contracts to ensure accurate and timely payment decisions
Review complex claim scenarios with attention to medical policy benefit design and coding details to minimize financial leakage and reduce rework
Validate claims data integrity by checking member eligibility coverage limits and coordination of benefits to prevent processing errors and denials
Apply HIPAA privacy and security requirements in all claim han...