Claims Examiner Contractor

About the role

Smart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Claims Examiner Contractor to join our team.

Responsibilities

• Identify, research, process and resolve claims according to desk level procedures (DLP), business guidelines, and quality standards.
• Meet established productivity and timeliness standards to achieve individual and departmental performance goals as defined.
• Capable of investigative and analytical research, demonstrating critical thinking and deductive reasoning.
• Consult and coordinate with various teams/departments to obtain information to ensure proper and timely resolution of claims.
• Demonstrate a high level of flexibility and adaptability; remain available to transition to different work groups based on business need.
• Employ strong organizational skills, make good use of work time, and demonstrate an ability to effectively use all available resources to meet established claims processing goals.
• Demonstrate and maintain current working knowledge of the client's systems, procedures, forms, and manuals as applicable.
• Experience with multi-tasking and prioritizing.
• Adhere to all corporate and client mandatory trainings, privacy and security protocols, time entry requirements, attendance and leave time policies and guidelines.
• Participate in departmental training and calibration meetings as needed.
• Establish and maintain working relationships in a collaborative team environment.
• Exhibit proactive approach by continuously reviewing personal and teamwork processes and sharing suggestions for improvements.
• Identify and support automation opportunities within assigned project work.
• Accurately document your time and the number of records processed daily.
• Perform other duties as assigned.

Requirements

• High School Diploma or equivalent.
• Experience using computer equipment such as laptops, monitors and routers.
• Intermediate level experience with MS Office products.
• Proficiency with Ten Key and Typing skills.
• Ability to read and interpret Standard Operating Procedure documents and performance / production reporting.
• Minimum of 1 year experience adjudicating claims and releasing for payment.
• Familiarity with medical claim forms CMS1500 and UB04.
• Knowledge and experience with Medical Code sets ICD 10, HCPCS, CPT and Modifiers.
• Conceptual knowledge of coordination of benefits, member/provider claim appeals, government programs (Medicare/Medicaid).
• Ability to maintain confidentiality and privacy.

Qualifications

• 3 years of experience in Health Care claim operations (preferred).
• Organizational skills and experience prioritizing project work and tasks.
• Experience in the health care industry working with Health Plans or Third-Party Administrators.
• Experience working in a remote environment.

Benefits

• A company culture that is authentic, innovative, and collaborative.
• Professional development and growth-oriented workplace.
• Generous benefits including health insurance, short-term, and long-term disability.
• 401(k) with a company match.
• A flexible environment with a competitive paid time off package; including vacation, holiday, give-back day, and a floating day.

Schedule

The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.