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Medical Claims Processor

1 month ago

Philadelphia, Pennsylvania, United States IQVIA Full time
Job Summary

We are seeking a highly organized and detail-oriented Medical Claims Processor to join our team at IQVIA. As a Medical Claims Processor, you will be responsible for receiving medical claims from healthcare professionals and patients, ensuring the adequate supporting documentation has been provided, and interpreting the EOB/CMS1500 to determine if the claim should be paid or rejected.

This is a contract role with IQVIA managed by an external agency, with the opportunity to be converted to an IQVIA full-time employee.

Key Responsibilities:
  • Receive medical claims from HCPs or patients and ensure supporting documentation is provided
  • Interpret EOB/CMS1500 and vet claims against program-specific business rules
  • Determine if claims should be paid or rejected
  • Provide exceptional customer service via telephone, email, fax, or other available means of contact
  • Recognize operational challenges and suggest recommendations to management as needed
Requirements:
  • High School Diploma or equivalent
  • Experience in claim processing required
  • Medical Billing and Coding Certification required
  • Ability to interpret Explanation of Benefits (EOB)
  • HIPPA certified
  • Customer Service Experience preferred
  • Pharmacy Technician experience preferred
About IQVIA

IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide.