Claims Processor - (Watertown, MA)

The focus of this position is to adjudicate, investigate and resolve claim issues for Network Health. Must have background with ICD9, CPT Codes and HCFA 1500. Background with workers compensation, TPA, slip and fall a plus. PRINCIPAL DUTIES AND RESPONSIBILITIES: - Process claims in accordance with Network Health's policies and procedures. - High-school diploma - Interact with various operational departments to assure accurate and timely payment of claims in accordance with the plan's policies and procedures. - Assist in developing recommendations for improvements to the claim processing system. - Participate in special claim projects, as needed. - Must have background with ICD9, CPT Codes and HCFA 1500. - Investigate and respond to providers regarding their claim issues. - Health Insurance experiences a plus. - 1-2 yrs background processing medical claims or working within a Managed Care Organization with direct interaction with the Claims Department - Other duties, as assigned.