Claims Examiner II

Scope Of Role & Responsibilities

• Process all claims identified as exceeding claim age parameters established within the unit (28+ days)
• Process complex, difficult, and non-routine claims for multiple lines of business
• Audit work of assigned claims examiners to ensure accuracy
• Identify policies of common errors requiring retaining sessions
• Assist with retraining sessions as directed
• Participate in quality projects as required by management

Required Education, Training & Professional Experience

• Bachelor’s degree is required; a Master’s degree is preferred, or an equivalent combination of education and relevant experience that demonstrates satisfactory equivalency
• At least three (3) years’ experience of claims in a managed care or hospital setting is required
• Strong data entry skills are essential
• In-depth knowledge of adjustment processing, medical terminology, CPT, ICD-P, and revenue codes is required
• Proficiency in Microsoft Office applications, including Word, Excel, and Access, is required

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication