Claims Examiner

Harris Computer•Washington, DC

19d

About The Position

Harris provides mission critical software solutions for the Public Sector, Healthcare, Utilities and Private Sector verticals throughout North America, Europe, Asia and Australia. Working for Harris is the perfect opportunity to fulfill your professional goals as well as achieve your personal dreams! Our employees enjoy a casual work environment that offers comfort while providing superior service to our customers. We offer a comprehensive benefit package as well as other additional “Perks”! We empower our employees to make a difference We have an award winning culture We offer opportunity to learn We are financially strong and we are owned by the largest software company in Canada (CSI) We have fun! Follow us on social media to learn more about our company values, culture and initiatives! Harris is an Equal Opportunity/Affirmative Action Employer. We consider applicants without regard to race, color, religion, age, national origin, ancestry, ethnicity, gender, gender identity, gender expression, sexual orientation, marital status, veteran status, disability, genetic information, citizenship status, or membership in any other group protected by federal, state or local law. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at (1)-613-226-5511 or at [email protected] This contact information is for accommodation requests only and cannot be used to inquire about the status of applications.

Responsibilities

Claims Processing and Assessment: Evaluate incoming claims to determine eligibility, coverage, and validity.
Conduct thorough investigations, including reviewing medical records and other relevant documentation.
Analyze policy provisions and contractual agreements to assess claim validity.
Utilize claims management systems to document findings and process claims efficiently.
Communication and Customer Service: Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements.
Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process.
Address customer concerns and escalate complex issues to senior claims personnel or management as needed.
Compliance and Documentation: Ensure compliance with company policies, procedures, and regulatory requirements.
Maintain accurate records and documentation related to claims activities.
Follow established guidelines for claims adjudication and payment authorization.
Quality Assurance and Improvement: Identify opportunities for process improvement and efficiency within the claims department.
Participate in quality assurance initiatives to uphold service standards and improve claim handling practices.
Collaborate with team members and management to implement best practices and enhance overall departmental performance.
Reporting and Analysis: Generate reports and provide data analysis on claims trends, processing times, and outcomes.
Contribute to the development of management reports and presentations regarding claims operations.