The Production Claims Analyst is responsible for the review, investigation, decision making, and processing of production claim types, and all related claim functions and activities.
Responsibilities
Review and adjudicate all types of claims designated as “production claims”, meeting production and quality goals.
Review, investigate, and apply all necessary criteria to determine validity of claim.
Understand the Anthem JAA workflow and apply JAA processing procedures, rules, and guidelines to adjudicate JAA claims.
Apply benefit plan rules and processing guidelines to pay, pend, or deny claims.
Qualifications
One to two years of college or equivalent experience.
Medical billing and/or AMA coding experience preferred.
Data Entry experience or equivalent type work using keyboard/PC.
Requires NYS Accident & Health Adjuster License with in 3 months of hire
