As a Clinical Claim Processor, I ensure accurate and timely medical claims processing. The role involves reviewing and evaluating claims, verifying policy coverage, and facilitating reimbursement payments while adhering to quality and productivity standards. Main tasks: Evaluate various claims condition codes and edits, including eligibility, benefits, member liability, pricing, and authorization, and adjust claims as needed, contact internal and external resources for additional information required for claims processing, research and apply solutions to expedite aged claims for payments or closure, detecting possible fraud situations. Main results: High performance in claims keying and document verification. Skills: Logical approach | Coding | Communication | Analysis | Problem solving | Data entry