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Complex Claims Processor

Tufts Health Plan – Watertown, MA

We enjoy the important work we do every day on behalf of our members.

Job Summary

The Complex Claims Processor is responsible for the timely and accurate processing of claim inventory as assigned by the Complex Claims and Improvement Support Supervisor.

Job Description

Using analytical and problem solving skills, the Complex Claims Processor is expected to fully research and resolve all complex issues and problem codes for each claim.



  • Associates degree or equivalent business experience in a claims/customer service healthcare environment preferred.


  • 12-18 months experience as a Claims Processor or similar claims processing or customer service experience required

SKILL REQUIREMENTS: Understanding of managed care concepts and a strong understanding of CPT, ICD-9 (ICD-10), HCPCS coding guidelines and CMS1500 & UB04 billing forms preferred. Position requires strong problem solving and analytical skills with the ability to multi-task. Must be able to work independently and as a part of a team. Advanced verbal and written skills to communicate internally and externally. Working knowledge of Microsoft Office applications and internet navigation is preferred.

What we build together changes our customer s health for the better. We are looking for talented and innovative people to join our team. Come join us!

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