Claims Resolution Representative


Augusta, ME

What you'll be doing

The candidate will responsible to process claim forms, adjudicates for allocation of deductibles, co-pays, co-insurance maximums and provider reimbursements. S/he will follow adjudication policies and procedures to ensure proper payment of claims. The position will also accountable to resolve pended claims based on Medicaid rules and regulation established for final processing. S/he will meet established production requirements consistently. S/he will also support all departmental initiatives in improving overall efficiency. Perform other duties as assigned by management if required.

What your background should be

1-2 years general office experience in a claims environment. Basic knowledge of Microsoft office outlook. General knowledge of pc. Good verbal and written communication skills. Ability to abide by company policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with health insurance portability and accountability act (HIPAA). Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers.

Required Schooling / Training

High school diploma or equivalent GED.

Who is the client company

This is a managed care company.
If you are interested in this position, send your resume to