Karna, LLC

Claims Specialist

• Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance.
• Analyze claims and adjudicate them according to program guidelines, employing critical thinking to navigate complex scenarios.
• Ensure claims are processed promptly to meet client standards and regulatory requirements, employing effective problem-solving skills to address any barriers.
• Proactively resolve claim discrepancies and issues by collaborating with other departments, utilizing analytical skills to identify root causes and implement solutions.
• Uphold the confidentiality of patient records and company information as per HIPAA regulations.
• Maintain thorough records of claims processed, denied, or requiring further investigation, ensuring transparency and traceability.
• Analyze and report on trends in claim issues or irregularities to management, contributing to process improvement initiatives; Assists Team Leads with reporting.
• Engage in audits and compliance reviews to ensure adherence to internal and external regulations, using critical thinking to evaluate processes.
• Mentors and trains new claims processors as needed.

Healthcare Claims Processor