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Job Summary: Processes claims for third party administrator after reviewing carrier EOB and determining benefit allocation by reviewing plan design and schedule of benefits. Reviews carrier and provider information to determine correct adjudication of third party benefit. Uses previous claim processing experience to interpret and understand unusual plan designs and coding procedures to process claims while maintaining high quality levels. Essential Functions: • Reviews carrier EOB and processes claims in accordance with employer benefit plan • Meets or exceeds established goals in relation to productivity and quality metrics. • Completes written communication with outside parties as needed to explain benefit payments and denials. • Researches carrier documents to ensure claim payments are accurate. • Utilizes benefit schedules and resources effectively to support claim payment process. • Works with Customer Service, Benefit Plan Loading and other areas to improve processes and workflows. • Works with IT department to ensure system processes work correctly. • Follows and adheres to all office policies, procedures and practices to enhance claim productivity and quality. • Demonstrates ability to assist team members with complex claims, adjustments and special projects. Competency Requirements: • Excellent organizational skills • Time management skills with focus on prioritizing tasks • Ability to work independently. • Problem solving and decision making experience. • Detail orientation with experience in analyzing data. • Proven interpersonal skills to interact with other areas. • Computer knowledge with skill to navigate Web and locate carrier documents Required Skill / Experience: • Claim processing experience, two years preferred • Knowledge of carrier benefit plans and processes • Excellent communication skills - written and verbal.