Claims Investigator/Examiner
About the role
The Claims Department is a dynamic team that provides claims examination and adjudication for the organization’s multiple health plans, AHF grants, and contracts. The Claims Investigator-Examiner contributes to AHF's mission by ensuring accurate, timely payment of claims and delivering a positive experience to providers and internal staff. Reliable claims handling enhances provider satisfaction and retention rates.
The Claims Investigator-Examiner improves the experience of providers and the organization by being knowledgeable, friendly, and helpful, offering accurate and thorough responses to inquiries about claims. This role supports the organization’s success by maintaining a deep understanding of health plan eligibility, benefits, and procedures while staying current with contractual, regulatory, compliance, and quality standards related to claims review, processing, and payment.
Attention to detail, analytical skills, and excellent customer service are critical to the Plan’s overall success.
Responsibilities
- Examine and adjudicate claims for multiple health plans, grants, and contracts.
- Ensure accurate and timely payment of claims to maintain provider satisfaction and retention.
- Respond to provider and internal staff inquiries with accurate, thorough, and helpful information.
- Maintain a comprehensive understanding of health plan eligibility, benefits, and procedures.
- Stay abreast of contractual, regulatory, compliance, and quality standards related to claims processing.
- Apply analytical skills and attention to detail in claims review and decision-making.
- Contribute to a positive experience for providers and internal stakeholders through professionalism and expertise.