Job Description

Job Description

This position exists to evaluate and enforce claim benefits and limitations based on a comprehensive understanding of the applicable policy wording. The claims assessor is responsible for qualifying a claim/bill for payment. Claims are reviewed for customer service and may require direct client contact. The assessors are responsible to contribute to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges.

What does your typical day look like?

  • Validate claim coverage;
  • Confirm clean bill components are present;
  • Review all verbal and written communication within the file;
  • Review applicable policy wording;
  • Review bills for rendered services, coding and reasonable & customary charges;
  • Ensure bills are directed to the appropriate internal financial process;
  • Claims are reviewed with precision for compliance with expressed ...

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