Claims Examiner
Summary
The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.
Duties and Responsibilities:
- Accurately review all incoming Provider claims to verify necessary information is available.
- Meets production standards of 100-150 claims as established by claims management
- Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
- Coordinate resolution of claims issues with other Departments.
- Assist Providers, Members and other Departments in claims research.
- Provide backup for other examiners within the Department.
- Assist in training of new claims personnel.
- Promote a spirit of cooperation and understanding among all personnel.
- Attend organizational meetings as required
- Adhere to organizational policies and procedures.
- Performs other tasks as assigned by supervisor/manager
- Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration
Minimum Job Requirements:
High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills. Ability to generate claims status reports and/or check runs.
Skills and Abilities:
- Experience in a managed care environment preferred.
- ICD-10 and CPT-4 coding knowledge preferred.
- Must be detail oriented and have the ability to work independently
Salary Range:
- $20 - $25 hourly
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