Claims Examiner

Apply Now – Paid Training Starts October 25th 2021

 

POSITION SUMMARY:
The Claims Examiner is responsible for reviewing, evaluating, and authorizing payments on medical, dental, and vision claims according to the health plan rules. The claims examiner must correctly adjudicate (process) claims and provide accurate and timely responses to plan participants.

 

KEY COMPETENCIES:
• Excellent verbal and written communication skills
• Computer proficiency and working knowledge of Microsoft Office Word/Excel.
• Ability to work independently with excellent judgment
• 10 key by touch
• Must be a quick learner, able to multi-task, able to problem solve and the ability to keep information confidential.
• Strong skills in time management, organization, and problem solving required.

 

JOB DUTIES:
• Review and research paper and EDI (Electronic Data Interchange) medical claims, physician and hospital billings and physician reports.
• Define coverage and process group health, dental, vision and prescription claims on an on-line system.
• Research claims in order to apply the proper limitations and provisions of each plan.
• Read, interpret, understand and apply contract benefits, limitations and provisions.
• Understand and apply insurance laws and regulations.
• Refer to various manuals, fee schedules and reference materials to obtain accurate information.

 

QUALIFICATIONS:
• Must be 18 years or older
• High School Diploma or GED.
• Authorization to work in the United States
• Knowledge of medical terminology, CPT, HCPCS and ICD-10 codes required.
• Experience in a healthcare related field required.
• 1 yr. medical claims adjudication processing required.
• Experience in self-funded plan administrations a plus.

 

REQUIREMENTS:
• Internet services – require minimum connection of 10Mbps upload and download speed and Jitter less than 30ms. A DSL or cable internet connection is required. (A satellite connection will not work properly due to latency.)

 

COMPANY OVERVIEW:
With over 450,000 covered members and 400+ clients, HealthComp is the nation’s largest leading independent health plan administrator for self-funded employer groups. HealthComp has been dedicated to transforming benefits administration for over 25 years. Bringing together concierge-level service, operational excellence, powerful analytics and cost management, our solution integrates seamlessly with any benefits ecosystem. HealthComp has offices in California, Illinois, West Virginia and Pennsylvania. For more information, visit HealthComp.com.

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