Medical Claims Examiner:
- Reviews medical claim(s) for completeness and accuracy
- Manages a caseload of insurance claims to assess their validity or if further investigation is required
- Consults policy & pertinent files to verify the information reported in a claim
- Authorizes payment, denies the claim or refers the claim to an investigator for a more thorough review
- Keeps current files with all the appropriate forms, statements and reports, and maintains medical records, reports and correspondence
- Responds to customer inquiries as needed in areas relevant to medical claims status
· Needs to be detail-oriented, precise and thorough, to be familiar with medical terminology and health insurance administration processes and to have good judgment and integrity
· Requires a minimum of 1-2 years experience in medical claims processing, medical terminology, ICD10 and CPT knowledge. Experience is Temporary Health Plans/Short Term Medical is a plus.
· Customer service experience is helpful
· Exemplary verbal and written communication skills
· This position is a Salaried position with a 40-hour work week with hours of operation between 8:30 am-5:00 pm Monday through Friday.
Earnings and Benefits
· Salary is dependent on experience. This position is eligible for Health, Dental, Vision, Life, and STD insurance benefits. Paid Time Off is an additional benefit for this position.