Claims Examiner Support Specialist

Job Description

Job Description

Essential Job Duties & Responsibilities

 

1. Processing Health Plan Delegated Claims:
2. • Reviewing claim submissions for accuracy and completeness.
   • Verifying information provided in claims to ensure it aligns with established guidelines.
   • Adjudicating claims according to the policies and regulatory guidelines set by the health plans.
   • Ensuring the accurate and timely processing of delegated claims.
3. Answering Phone Calls:
4. • Handling incoming phone calls from healthcare providers and other stakeholders.
   • Providing prompt and accurate responses to inquiries related to claims processing.
   • Documenting phone calls to include topics discussed and resolution.
   • Addressing concerns and questions from providers regarding claims.
   • Assisting with claim-related issues and resolving problems over the phone.
5. Administrative Functions:
6. • Performing various administrative tasks to support the efficient operation of the claims processing department.
   • Conducting data entry accurately and efficiently.
   • Logging disputes and tracking their resolution process.
   • Processing incoming mail related to claims and ensuring timely distribution.
   • Handling other clerical duties as assigned by supervisors or managers.
7. Other Duties as Assigned:
8. • Being flexible and willing to take on additional responsibilities as needed.
   • Adapting to changes in workflow or procedures within the claims processing department.
   • Collaborating with team members to achieve overall departmental goals.

 

To excel in this role, attention to detail, knowledge of healthcare claim processing, and effective communication skills are crucial. You must be familiar with the specific guidelines and policies of the health plans you are working with and stay updated on any changes. Additionally, maintaining a customer-centric approach when dealing with inquiries and issues is essential to ensure a positive experience for providers and stakeholders.

 

Experience

 

·         1 year of call center experience preferred

·         6 months claims adjudication experience preferred

·         1 year experience in Claims department is a plus

Education

 

·         High School diploma or equivalent GED

Knowledge, Skills & Abilities

 

·         Basic knowledge of healthcare terminology, coding, and claim processing procedures.

·         Strong attention to detail and accuracy in data entry.

·         Good communication skills, both written and verbal.

·         Ability to adapt to changing guidelines and procedures.

·         Familiarity with relevant software and computer skills for data entry and claims processing systems, a plus.

·         Basic knowledge of Microsoft Office including Outlook, Word, Excel, and Teams.

·         Data Entry/Typing skills, a minimum of 50 words per minute.

·         Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers, and customers.

·         Ability to multi task, as needed.

 

Work Hours, Travel Requirements

·         Monday – Friday, 8:00 a.m. – 5:00 p.m., and as needed to complete projects.

·         Travel to medical offices may be necessary for the purpose of providing benefit education. 

Company Description

Who We Are:
Peyton Resource Group (PRG) has a 20-year track record of delivering real results for our clients. With offices in Dallas, San Antonio and Austin, PRG is an innovative industry leader utilizing the latest technology to drastically reduce the time-to-hire problem plaguing most companies today.
What We Do: We innovate. We understand. We collaborate. We move forward. We get IT done.

How We Do It:
We partner with world-class organizations that offer exciting career paths to their employees.
We cultivate relationships with the best and brightest talent in the marketplace.
We leverage technology in a way that is helping to redefine the staffing industry.
Our Results: We solve today's critical staffing challenges, while delivering best-of-class professionals to our clients.

Company Description

Who We Are:\r\nPeyton Resource Group (PRG) has a 20-year track record of delivering real results for our clients. With offices in Dallas, San Antonio and Austin, PRG is an innovative industry leader utilizing the latest technology to drastically reduce the time-to-hire problem plaguing most companies today.\r\nWhat We Do: We innovate. We understand. We collaborate. We move forward. We get IT done.\r\n\r\nHow We Do It:\r\nWe partner with world-class organizations that offer exciting career paths to their employees.\r\nWe cultivate relationships with the best and brightest talent in the marketplace.\r\nWe leverage technology in a way that is helping to redefine the staffing industry.\r\nOur Results: We solve today's critical staffing challenges, while delivering best-of-class professionals to our clients.