Claims Examiner

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Vision insurance
• Wellness resources

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. Researches, 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. Skill 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

This is a remote position.

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