Claims Examiner
customer service, Claims examiner The job duties include processing routine claims with single product line to determine type and amounts of benefit payable.
This is a great job for someone with excellent analytical skills, works well independently, and is comfortable with deadlines and stringent productivity levels.
This position is also suitable for recent graduates who are seeking experience in industries that offer lots of room for advancement.
Important note: This position encompasses an intensive three-month paid training course from our client.
Essential Duties: Determines level of reimbursement based on established criteria, provider contract, plan and employer group provisions.
Reviews all decisions with supervisor or senior staff.
With approval, processes all claims eligible or ineligible for payment accurately and confirming to quality production standards and specification in a timely manner.
Documents provider claims/billing forms to support payments/decisions.
Matches authorization to claims and maintains current desk procedural and reference materials.
Reviews appeals and complaints; research any missing or required information.
You will not be handling incoming/outgoing calls and claims simultaneously.
Qualifications: HS Diploma or equivalent Excellent study habits, test taking skills, and classroom etiquette Strong communication skills/analytical skills Computer Knowledge, MS Word and MS Excel Typing of at least 45 wpm Preferred Qualification: Ability to read and interpret benefit contracts Ability to recognize hemo/chemo codes and home health procedure codes At least 6 months of claims examining experience For immediate consideration please send your resume and contact info.
to Elizabeth [at] norlandgroup [dot] com
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