Claims Processor - (Watertown, MA)

The focus of this position is to adjudicate, investigate and resolve claim issues for Commercial Products. Must have background with ICD9, CPT Codes and HCFA 1500. Background with workers compensation, TPA, slip and fall a plus. PRINCIPAL DUTIES AND RESPONSIBILITIES: - Must have background with ICD9, CPT Codes and HCFA 1500. - 1-two years background processing medical claims or working within a Managed Care Organization with direct interaction with the Claims Department - Strong written and spoken communication expertise Bi-lingual preferred - Participate in special claim projects, as needed. - Process claims in accordance with Tufts Health Plan's policies and procedures. - Maintain department production and quality qualifications. - Investigate and respond to providers regarding their claim issues. - Health Insurance experiences a plus. - Interact with various operational departments to assure accurate and timely payment of claims in accordance with the plan's policies and procedures.