Claims Examiner II - Provider Projects

HealthEdge • Remote,

5d • $40,000 - $44,000 • Remote

About The Position

UST HealthProof is looking for a 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. HealthEdge offers AI-powered operational infrastructure for health insurance companies, guaranteeing an enduring financial edge in an increasingly competitive market. UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations that helps our customers achieve affordable, equitable health care for all. We have a strong global presence, with a workforce of over 4,000 people built on a foundation of simplicity, integrity, people-centricity, and leadership.

Requirements

• Solid understanding and ability to analyze claim data
• High School degree required
• 1 – 3 years healthcare claims processing experience
• Willingness to learn new skills
• Team collaborator
• Strong work ethic
• The ability to adapt quickly to a fast-paced environment
• A self-starter and quick learner
• Team player with an ability to collaborate

Nice To Haves

• ICD-10 CPT and HCPCS coding

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

Benefits

• Health insurance
• Dental insurance
• Vision insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED