Senior Claims Processor - (Pittsburgh, PA)

Company :Gateway Health PlanJob Description : GENERAL OVERVIEW: This section contains a synopsis of the main purpose(s) or functions(s) of the job, indicating what is done.This details will be used to develop the position posting. Screens, reviews, evaluate on-line entry, error correction and / or quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures. May include initial entry claims or claims which have suspended. Translate foreign language claims into English using software and code appropriately. Convert foreign currency to US dollar and code fees appropriately. Reviews processed claims and inquiries to determine corrective action which can include adjusting claims. Takes the corrective action steps using enrollment, benefit and historical claim processing info.