Claims Examiner

Responsibilities

• Ensure customers and providers are paid timely and accurately.
• Communicate effectively with internal and external customers.
• Handle customer reimbursement requests.
• Validate daily NHS wire payments and exceptions.
• Manage the reconciliation of Customer Preferred Pricing transactions.
• Absorb inquiries regarding claim status with customers.
• Analyze and validate a high level of claims data and enter it into a proprietary operating system.
• Index invoices received in the inbox and move them to the appropriate location.
• Perform filing and other administrative duties as needed.

Requirements

• Minimum of 1 year of office experience in data entry, dispatching, claims, or provider relations.
• Proficiency in Microsoft Office suite.
• Experience working in a fast-paced environment.
• Strong attention to detail and organizational skills.
• Effective verbal and written communication skills.
• Ability to adapt to changing priorities and learn new processes quickly.
• GED/High School Diploma minimum.

Qualifications

• Self-starter with creative problem-solving skills.
• Persuasive and thorough team player.
• Experience with Salesforce CRM, invoicing, and reimbursements.

Work Environment

The role is within the Claims Management Department, consisting of a team of 16, including 2 Claims Supervisors and 14 Claims Examiners. Initial training lasts 2-4 weeks, with hours from Monday to Friday, 7:30am to 4pm. Post-training, employees can choose from several shifts: Monday to Friday, 7am-3:30pm, 7:30am-4pm, or 8am-4:30pm. Work from home is available on Mondays and Fridays after training. The office is located in a brand-new facility in Naperville, featuring a modern 'pit-style' environment, great energy, and a nice kitchen area with a soda machine.

Job Type & Location

This is a Contract position based out of Naperville, IL.

Pay And Benefits

The pay range for this position is $20.00 - $20.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

About the Role

The Claims Examiner role entails the review, investigation, evaluation, and determination of eligibility for claims. The Claims Examiner negotiates the resolution of claims in compliance with all policies and state regulatory requirements, while managing a large volume of claims.