Health Insurance Claims Representative

Processing health insurance claims remotely, the full-time Associate Claims Representative will validate claims, ensure accuracy, and determine coverage based on defined workflows. Key responsibilities Release health insurance claims for payment and validate them for completeness and accuracy Review claims using medical necessity and eligibility guidelines to determine coverage and benefit levels Respond to information requests from other departments and refer complex claims to senior representatives Required qualifications High school diploma or equivalent required; some college coursework preferred One year of applicable experience required, with medical claims processing experience preferred Demonstrable computer literacy and basic knowledge of Microsoft Office Analytical ability with a keen attention to detail Ability to maintain confidentiality and a desire to learn