Claims Investigator/Examiner

About the role

The Claims Department is a dynamic department that provides claims examination and adjudication for the organization’s multiple health plans and AHF grants and contracts. The Claims Investigator-Examiner contributes to AHF's mission by ensuring accurate and timely payment of claims and providing a positive experience to providers and internal staff.

Reliability in the handling of claims ensures internal/external providers’ satisfaction and high retention rates. The Claims Investigator-Examiner enhances the experience of providers and the organization by being knowledgeable, friendly, and helpful and by offering accurate and thorough responses or instructions to enquiries about claims.

The Claims Investigator-Examiner contributes to the success of the organization by maintaining a thorough understanding of the organization’s health plans eligibility, benefits, and procedures while keeping abreast of various contractual, regulatory, compliance, and quality standards as related to claims review, processing and payment.

The Claims Investigator-Examiner’s attention to detail, analytic capabilities, and excellent customer service play a large role in the Plan’s overall success.

Responsibilities

• Ensuring accurate and timely payment of claims
• Providing a positive experience to providers and internal staff
• Enhancing the experience of providers and the organization by being knowledgeable, friendly, and helpful
• Offering accurate and thorough responses or instructions to enquiries about claims
• Maintaining a thorough understanding of the organization’s health plans eligibility, benefits, and procedures
• Keeping abreast of various contractual, regulatory, compliance, and quality standards as related to claims review, processing and payment
• Contributing to the success of the organization by demonstrating attention to detail, analytic capabilities, and excellent customer service

Qualifications

• Bachelor’s degree in healthcare, business administration, or a related field
• At least 2 years of experience in claims processing or related field
• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Knowledge of healthcare regulations and compliance standards

Skills

• Strong analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Knowledge of healthcare regulations and compliance standards

Benefits

• Flexible work schedule
• Health, dental, and vision insurance
• 401(k) retirement plan
• Professional development opportunities

Pay

Competitive salary commensurate with experience

Schedule

Full-time position