Claims Examiner II
About The Position
HealthEdge® offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. We're experiencing strong market momentum, with a growing number of health plans choosing HealthEdge to modernize their operations and compete more effectively. As we expand, we're investing in the people who power that growth, making this a pivotal moment to join us and shape the future of healthcare technology. Learn more at HealthEdge.com. At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth. UST HealthProof is looking for Claims Examiner II, reporting to the Claims Team Leader. The Claims Examiner II is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. This role is responsible for reviewing data within the claims processing system, to determine if services rendered were appropriate and benefit coverage criteria were met. The Claims Examiner II is accountable for reviewing the adjudication system edits to determine whether to pay the claim and/or line item(s).
Requirements
- High School degree required
- 1 – 3 years healthcare claims processing experience
- Solid understanding and ability to analyse claim data
- Willingness to learn new skills
- Team collaborator
- Strong work ethic
Nice To Haves
- ICD-10 CPT and HCPCS coding, is a plus
Responsibilities
- Processing assigned claims based on client-specified guidelines or as directed by the team leader
- Meeting productivity targets, financial and procedural accuracy standards as established by management
- Mentoring junior members of the team
- Collaborating with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader
- Establishing and maintaining an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality
- Participating in projects assigned by the team leader; these projects may include provider data, authorizations, enrollment, or other activities
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
