Medical Billing Processor - Lincolnwood
4 days ago

Job summary
The Claims Adjuster investigates evaluates and resolves complex high-dollar or disputed health insurance claims.Responsibilities
- Complex Case Investigations: Handle escalated claims involving multi-layer benefits COB subrogation prior authorization disputes and medical necessity.
- Evidence Review: Analyze medical records clinical notes coding authorization history and provider contracts to determine claim outcomes.
- Determinations & Negotiations: Make coverage and payment decisions negotiate settlements with providers recommend denials or adjustments with clear rationale.
Job description
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