• Responsible for the review and processing of claims within the claims transactional system, according to plan benefits and contractual reimbursement terms. • Follows established policies and procedures to pay, pend for additional information, or deny claims. • Process claims subject to Coordination of Benefits (COB) according to plan benefits, COB rules and contractual reimbursement terms • Accountable to meet and maintain established department production and quality standards. • Create claim test cases, execute, and report on the results. • Identify and communicate defects or claim system issues to those responsible for configuration. • Work with configuration to remediate and retest defects. • Identify and communicate inventory issues to department’s management. • Works with internal departments, vendors, business partners, providers, etc. to help coordinate problem solving in an effective and timely manner. • Develop and maintain desk top procedures related to claim adjudication. • Audit auto-adjudicated and/or manually processed claims. • Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins.