Claims Examiner I (Remote, $15/hour)

Responsibilities

• Processes claims accurately and efficiently.
• Reviews all incoming claims to verify necessary information.
• Determines that correct member and provider records are chosen and utilized to process claims.
• Enters claims data and information into the computerized Claims Processing System.
• Maintains all required documentation of claims processed and claims on hand.
• Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.
• Maintains production standards; for direct data entry claims this includes processing an average of 31 claims per hour, with an accuracy rate of 98.5% over each pay period.
• Verifies data of scanned paper claims at stated standards.
• Provides backup for other examiners within the department.
• Promotes a spirit of cooperation and understanding among all personnel.
• Attends organizational meetings as required.
• Adheres to organizational policies and procedures.
• Maintains confidentiality of all claim files, claims reports, and claims related issues.
• Performs other duties as assigned.

Qualifications

• A High School Diploma or GED certificate required.
• 6 months data entry experience with 10 key and word processing; minimum 10,000 keystrokes per hour required.
• Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.
• Proficient in MS Office.
• Ability to work and maintain production in a work-from-home (WFH) environment.
• Demonstrated ability to show self-discipline to meet production goals.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
• Ability to effectively organize, prioritize, multi-task and manage time.
• Demonstrated accuracy and productivity in a changing environment with constant interruptions.
• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.
• Ability to exercise strict confidentiality in all matters.