Claims HMO - Claims Examiner 140-1060

The Claims Examiner is responsible for examining claims that require review prior to being adjudicated.

What You Will Do

Examining and adjudicating claims, identifying trends or problems, and communicating with team members.

Why It Might Be a Fit

Self-motivated and able to work with minimal direction, with a high attention to detail and strong communication skills.

Requirements

• Self-motivated and able to work with minimal direction
• Ability to read and understand claims processing manuals, medical terminology, CPT codes, and perform basic processing procedures
• Ability to read and understand health benefit booklets
• Demonstrated learning agility
• Successful completion of Health Care Sanctions background check
• Knowledge in the contracted managed care plan terms and rates
• General understanding of unbundling methods, COB, and other over-billing methodologies
• Must have high attention to detail
• Proficient in Microsoft applications
• Ability to perform basic mathematical calculations
• Possess strong oral and written communication skills