• Review medical claims thoroughly to ensure no missing or incomplete information • Navigate multiple computer systems and platforms to research and process assigned claims accurately (e.g., verifying pricing, prior authorizations) • Apply appropriate benefits to each claim in accordance with claims processing policies, including grievance procedures, state mandates, CMS guidelines, and benefit plan documents • Review documentation to assess whether the visit was necessary and whether the policy covers the treatment received • Determine if claims should be paid or denied, and complete denial letters when applicable