• Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. • Adjudicate claims according to program guidelines, applying critical thinking skills to navigate complex scenarios. • Ensure prompt claims processing to meet client standards and regulatory requirements. • Identify and resolve any barriers using effective problem-solving strategies. • Collaborate with internal departments to proactively resolve discrepancies and issues. • Use analytical skills to identify root causes and implement solutions. • Uphold confidentiality of patient records and company information in accordance with HIPAA regulations. • Maintain thorough and accurate records of claims processed, denied, or requiring further investigation. • Analyze and report trends in claim issues or irregularities to management. • Assist Team Leads with reporting to contribute to continuous process improvements. • Engage in audits and compliance reviews to ensure adherence to internal and external regulations. • Critically evaluate and recommend process improvements when necessary. • Mentor and train new claims processors as needed.