Claims Examiner - Jefferson Health Plan

Claim Examiner

Working under general supervision, the Claim Examiner adjudicates medical claims, in accordance with Health Partners' policies and procedures.

Job Duties

• Able to work in a constant state of alertness and safe manner
• Accurately adjudicates claims in compliance with data entry rules, On Line Processing Rules and contractual agreements.
• Reviews pended claims on a daily basis, assuring that all appropriate documentation is completed before adjudication.
• Accurately completes service forms for pended claims and routes to designated areas for resolution.
• Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes.
• Follow established procedures and guidelines for claims processing and high dollar claim review.
• Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy.
• Keeps current with Claims Department policies and procedures.
• Assist the unit in meeting and maintain performance standards.

Minimum Qualifications

• High School Diploma/GED
• Ability to maintain strict confidentiality of patient information obtained in the performance of job function

Preferred Qualifications

• 2 years claims processing experience or provider billing experience
• Excellent communication skills required-both oral and written
• Basic understanding of computer applications
• General understanding of the principles of Managed Care

Work Shift: Workday Day (United States of America)

Worker Sub Type: Regular

Employee Entity: Health Partners Plans, Inc.

Primary Location Address: 1101 Market, Philadelphia, Pennsylvania, United States of America