CLAIMS EXAMINER

BRMS•Folsom, CA

2h•$24 - $25•Onsite

About The Position

The Claims Examiner I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Processes claims by performing the following duties. This position requires the employee to work in the office.

Requirements

Excellent written and verbal communication skills.
Strong analytical skills and problem-solving skills.
Must be dependable and maintain excellent attendance and punctuality.
Must be able to perform data entry operations quickly and accurately.
Ability to grow with changing demands of the position and the company.
Strong computer skills, including Word, Excel, and Outlook.
Successful candidates must have experience processing medical claims for an insurance company or third party administrator.
Must be highly proficient in ICD-10, CPT, and HCPCS codes.
Ability to read, speak, and write effectively in English.
Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports, meeting notes, project documentation, and correspondence.
Ability to speak effectively before customers or employees of organization.
Ability to effectively address or resolve customer service issues within guidelines of the position.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized or non-standardized situations.
Valid, class C license in state working with no adverse driving record.

Responsibilities

Compares data on claim with internal policy and other company records to ascertain completeness and validity of claim.
Comprehensive understanding of employee benefits for medical, dental and vision plans.
Adjudicates medical claims, applies coordination of benefits as outlined in plan guidelines and works with providers to gather the necessary documents to make final payment determination on claims.
Ensures all claims are coded properly.
Examines Summary Plan Document, claim adjustors' reports or similar claims/precedents to determine extent of coverage and liability.
Maintains high quality standards to avoid paying claim incorrectly.
Maintains productivity standards set by Management.
Refers most questionable claims for investigation to claim examiner II for review and processing.
Research and resolve paid and denied claims escalations from internal sources and/or TIPS ticketing system when assigned.
Works from the claims queue manager to process & releases claims for adjudication and payment within 3-5 days of receipt.
Performs other duties and responsibilities as assigned by Management.