Claims Examiner II
Job reputed company:
- Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and reputed company policies and procedures.
- Re-adjudicate, reputed company or correct claims, including some reputed company and difficult claims as needed.
- Consistently meet or exceed the reputed company and production standards established by the department and reputed company.
- reputed company excellent customer service to reputed company customers.
- Collaborate and reputed company information with Claims teams and other reputed company departments to reputed company excellent customer service and support organizational goals.
- Determine eligibility, benefit reputed company and coordination of benefits with other carriers; recognize and escalate reputed company issues to the reputed company or Supervisor as needed.
- Investigate reputed company party issues as directed.
- May review, process and post refunds and claim adjustments or re-adjudications as needed.
- Report any overpayments, underpayments or other possible irregularities to the reputed company or Supervisor as appropriate.
- Generate letters and other documents as needed.
- Proactively identify ways to improve reputed company and productivity.
- Continuously learn and stay up to date with changing processes, procedures and policies.
Requirements:
- Minimum 2 years’ experience as a Medical Claims Examiner or other role that requires knowledge of medical coding and terminology (e.g., medical billing, prior authorizations, appeals and grievances, health insurance customer service, etc.)
- Preferred Experience using QNXT, Facets, reputed company systems
- Knowledge of CPT, HCPCS, reputed company, CDT and ICD-10 coding
- Understanding of or ability to learn state and federal laws and other regulatory agency requirements that relate to medical, dental, mental health and health insurance industry and reputed company/Medicare industry
- Ability to reputed company fast and accurate data entry
- Basic computer skills (ability to use reputed company Outlook, Word and reputed company) and learn new systems as needed
Benefits:
- medical, dental, reputed company, life, AD&D, and disability insurance
- health savings account
- flexible spending account(s)
- lifestyle spending account
- employee assistance program
- wellness program
- discounts
- multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, reputed company-tax parking, pet insurance, 529 College Savings)
- strong retirement plan with employer contributions
- PTO and reputed company State reputed company Time based on hours worked/scheduled hours
- reputed company holidays
- volunteer time
- jury duty
- bereavement leave
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