Claims Examiner

Summary

The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Research, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.

Duties and Responsibilities:

• Accurately review all incoming Provider claims to verify necessary information is available.

• Meets production standards of 100-150 claims as established by claims management

• Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims.
• Coordinate resolution of claims issues with other Departments.
• Assist Providers, Members and other Departments in claims research.
• Provide backup for other examiners within the Department.
• Assist in training of new claims personnel.
• Promote a spirit of cooperation and understanding among all personnel.
• Attend organizational meetings as required
• Adhere to organizational policies and procedures.
• Performs other tasks as assigned by supervisor/manager
• Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration

Minimum Job Requirements:

High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills. Ability to generate claims status reports and/or check runs.

Skills and Abilities:

• Experience in a managed care environment preferred.
• ICD-10 and CPT-4 coding knowledge preferred.
• Must be detail oriented and have the ability to work independently

Salary Range:

• $22-$26 per hour