1 sr claim specialist jobs found in Bothell, WA

Position Summary The Claims Technical Review Specialist, Sr provides advanced quality review of claims processing and delivers practical training to improve team effectiveness and efficiency in accordance with Company guidelines, client needs, and regulatory requirements. "Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role." Key Duties and Responsibilities Reviews the work of new hires and existing employees; audits claims processing to identify areas for individual performance improvement; provides instructional feedback to increase team members’ skill level in claims processing. Performs technical review and analysis of all types of claims, including large dollar and technically complex claims, to ensure accuracy and adherence to prescribed procedures and plan guidelines. Identifies potential procedural or system issues and suggests possible solutions for process and...