claims processing or medical/vision Specialist needs 2 years practical work experience in claims, service or health services environment.

claims processing or medical/vision Specialist requires:

• knowledge of claims processing or medical/vision benefits and product experience


• Quality assurance experience


• 2 years practical work experience in claims, service or health services environment.


• One year experience in healthcare related appeals/grievances,


• High level of professionalism and ability to deal with sensitive information


• Strong oral and written communication skills


• Ability to work well under pressure and multi-task


• High sense of urgency and ability to manage to strict deadlines


• Demonstrated resourcefulness in resolving problems


• Demonstrated ability to learn new technology systems and query reporting

claims processing or medical/vision Specialist duties:

• Follow up with providers to obtain missing information for clean claim to ensure approval/denial from Medical Director.


• Compose letter to inform provider of approval/denial of medically necessary claim. Log, track and report on all medically necessary claims.


• Meets established productivity and quality standards.