Claims Examiner

Overview WelbeHealth is transforming senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, while serving as a care provider and care plan to those we serve. The Health Plan Services team ensures excellent care delivery for participants, and the Claims Examiner plays a pivotal role in the timely and efficient processing of claims for contracted specialty provider partners. Responsibilities Assess appropriateness of returned, denied, or paid claims by reviewing and following contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards Work alongside manager to establish and maintain claims processing rules that meet all regulatory and business requirements Assist internal and external partners with questions related to claims decisions or claims statuses Job Requirements Minimum of three (3) years of experience with processing, researching, and adjudicating claims in a complex managed care environment In-depth experience with Medicare and Medicaid claims processing Demonstrated skills within Microsoft Office Applications & electronic claims processing systems Diversity, Equity and Inclusion WelbeHealth embraces the diversity of our team members and is committed to building a culture of inclusion and belonging. We are an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law. #J-18808-Ljbffr