Claims Examiner

Claims Examiner

The Claims Examiner is responsible for assisting with development of all State Requirement Reports and assisting with medical and dental claims adjudication including resolving and researching all system issues with IT/Database department.

Typical Duties:

1. Acts as a liaison between Claims Department and IT Department.
2. Identifies claims system errors and report them to IT, coordinate with IT Department on all open issues.
3. Ensures Reprise Facility claims through Internet base system.
4. Researches claims issues in an automated system; maintains record keeping of all claims open issues.
5. Ensures all claims reporting requirements are met; complete daily production reports and weekly pending reports.
6. Prepares customer service log reports; support and back up claims and customer service department as needed.
7. Processes professional, facility and dental claims and provide phone back up as needed to meet departmental guidelines.
8. Maintains appropriate work habits, assist in training employees.
9. Performs other related job duties as assigned.

• Required Education and Experience: High School Diploma or GED. 3 plus years of Benefits and Claims experience. 3 plus years of Managed Care experience.
• Preferred Education and Experience: Associates Degree or two years of college.

Location Address: 1350 S. Main Street Fort Worth, Texas, 76104 United States