Claims Examiner

Job Description

Job Description

Job Title: Claims Examiner

Department: Claims

Reports to: Claims Supervisor

Date:

Job Summary

Are you looking for a career where you can apply your experience and passion for providing world class service to help our customers find solutions to their questions, if the answer is yes, then you found the perfect fit!

SureGo Administrative Services is looking for someone who is self-motivated, enthusiastic, thoughtful, and patient. Our Claims Examiners must have strong problem-solving skills, coupled with the natural ability to provide empathy for the customer – always taking the time to patiently listen and understand their questions to help find a viable solution, while providing them with a memorable customer experience.

This is a permanent work from home position that includes a virtual five week paid training program, which will successfully prepare you for handling incoming calls from our customers. At this time, we are accepting applications from individuals who reside in the United States only.

Key Responsibilities

• Diligently review reports to ensure that no errors have been made in the appraisal process.
• Determine whether payouts are reasonable.
• Approve, reject or refer a claim to a specialist.
• Meet with claimants and settle disputes.
• Ensure compliance with regulatory standards, company policy and guidelines.
• Provide assistance to claims adjusters to manage the volume of cases.

• Claims Examiners are responsible for timely processing and/or adjudicating medical claims according to the insurance policy provisions
• Read and interpret insurance policy language and adjudicate claims accordingly
• Respond to written communications from policy holders as needed with professionalism and knowledge based guidance
• Provide professional customer service to our internal and external customers

Qualifications

• Must have 1+ year of experience processing medical claims
• Familiarity with medical records, health charts, aftercare summaries and related medical documentation necessary and related to the processing of medical claims
• Current knowledge of medical coding sets HCPCS, CPT, ICD 10[GS1]
• Understanding of Medical terminology required
• Excellent verbal, written, and interpersonal communication skills
• Ability to prioritize and manage multiple tasks at once
• Ability to work independently with minimum guidance
• Strong data entry skills and attention to detail
• Minimum of High School Diploma or equivalent

Working Conditions

• Remote position.
• Private, secure, solo, distraction free workspace where you can work independently and take incoming calls during your shift.
• Computer equipment will be provided and shipped to you prior to your start date.
• Internet Connectivity Requirement/Remote Positions: For 100% remote positions, we require that: (you have high speed broadband cable internet service with minimum upload/download speeds of 3Mbps/30Mbps).

Benefits

• Monday-Friday, work from home schedule. Flex schedule with start times between 6AM-10AM
• 12 paid Holidays each year after 90 days
• Medical Insurance Benefits and PTO accrual after 90 days
• 401K investment options

Be part of a team committed to a culture of Respect, Ownership, Innovation and Integrity

We offer exceptional professional growth opportunities; a casual, friendly work environment; and competitive wage and benefits

SureGo Administrative Services LLC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to characteristics such as race, color, national origin, religion, gender, age, marital status, veteran status, citizenship status, sexual orientation, gender identity, or any other status protected by law.

[GS1]I know that ICD-9 is old-school and different from ICD-10, but I think maybe that knowledge might still be helpful and applicable in the role. Maybe worth listing? Like a "minimum of ICD-9"?