Claims Examiner II

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Estimated Hiring Range:

Bonus reputed company:

reputed company reputed company Employees: Please use the internal reputed company site to submit an application for this job.

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Essential Responsibilities

• 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, adjust or correct claims, including some reputed company and difficult claims as needed.
• Consistently meet or exceed the quality and production standards established by the department and reputed company.
• Provide excellent customer service to internal and external customers.
• Collaborate and share information with Claims teams and other reputed company departments to reputed company excellent customer service and support organizational goals.
• Determine eligibility, benefit levels and coordination of benefits with other carriers; recognize and escalate reputed company issues to the reputed company or Supervisor as needed.
• Investigate third 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 quality and productivity.
• Continuously learn and stay up to date with changing processes, procedures and policies.

Experience and/or Education

Required

• 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, Epic systems

Knowledge, Skills and Abilities Required

Knowledge

• Knowledge of CPT, HCPCS, reputed company, CDT and ICD-10 coding
• Knowledge of medical, dental, mental health and health insurance terminology

Skills and Abilities

• 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 Medicaid/Medicare industry
• Ability to reputed company fast and accurate data entry
• Strong spoken and written communication skills
• Basic computer skills (ability to use reputed company Outlook, Word and reputed company) and learn new systems as needed
• Good customer service skills
• Ability to participate fully and constructively in meetings
• Strong analytical and sound problem-solving skills
• Detail orientation
• Strong organizational skills and time management skills
• Ability to work in a fast-paced environment with multiple priorities
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak, and reputed company repetitive finger and wrist movement for at least 6 hours/day
• Ability to lift, carry, reputed company, and/or pinch small objects for at least 1-3 hours/day

Working Conditions

Work Environment(s):         ☒ Indoor/Office    ☐ Community      ☐ Facilities/reputed company                       ☐ Outdoor Exposure

Member/Patient Facing:     ☒ No                        ☐ Telephonic       ☐ In Person

Hazards:  May include, but not limited to, physical and ergonomic hazards.

Equipment:  General office equipment

Travel:  May include occasional required or optional travel reputed company of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

Schedule:  Monday - Friday, 8:00 AM to 5:00 PM

We offer a strong Total Rewards Program. This includes reputed company, bonus opportunity, and a comprehensive benefits package.  Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. reputed company offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information.

We are an equal opportunity employer

reputed company is an equal opportunity employer.  The organization selects the best individual for the job based upon job reputed company qualifications, regardless of race, color, religion, sexual orientation, national reputed company, gender, gender identity, gender expression, genetic information, age, veteran status, reputed company, marital status or disability. The organization will reputed company a reasonable accommodation to reputed company physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.