Claims Examiner II

Claims Examiner The Claims Examiner is responsible for providing expertise and/or claims support in reviewing, researching, investigating, processing and adjusting claims and other duties as necessary. Key Responsibilities Review, research, analyze and process professional claims by navigating multiple applications and platforms accurately. Ensure that the proper benefits are applied to the claim using the appropriate tools (e.g. CMS guidelines). Communicate with internal departments using clear, simple language to ensure understanding. Keep up via training with system updates and new applications. Meet and maintain the performance goals as established for the position in the area of quality and production. Qualifications High School Diploma or GED Excellent oral and written communication skills 13 years of Health claims processing experience Working knowledge of COB and MSP preferably Medical terminology Computer literacy Knowledge of current Medicare Advantage operational and regulatory guidelines established by CMS, AHCA and other federal and state regulatory guidelines. Excellent organizational skills Ability to work well under pressure and difficult situations Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. #J-18808-Ljbffr