Claims Examiner - Hybrid

Responsibilities

• Participate in training programs as available/requested
• Assist other departments during periods of backlogs
• Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork
• Process MCNet/Batch Edit errors in accordance with designated standards
• Maintain employee/insured confidentiality
• Work overtime as required per business need
• Identify areas of concern that may compromise client satisfaction
• Maintain mail date integrity
• Process standard to moderate claims, including COB, in accordance with company policies and procedures in a timely manner while meeting or exceeding production and quality standards
• Resolve outstanding holds in accordance with designated standards
• Effectively prioritize and complete all assigned tasks

Requirements

• High school graduate or equivalent required
• One year of claims processing and/or equivalent education preferred
• Knowledge of medical terminology, ICD-9, and CPT coding required
• Knowledge of commercial, Medicaid, and Medicare products
• Ability to use a QWERTY keyboard
• Competent in MS Office and PC skills preferred
• Working knowledge of COB (Coordination of Benefits) preferred
• Ability to demonstrate organizational, interpersonal, and communication skills
• Maintain designated production and quality standards required