Claims Examiner

firstsourc • Remo, VA

1d • Remote

About The Position

A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims need to be completed adhering to required TAT and quality SLA.

Requirements

• High School diploma or equivalent required
• Highly-motivated and success-driven
• Exceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills
• Exceptional analytical and problem-solving skills
• Strong attention to detail with a commitment to accuracy
• Ability to adapt to change in a dynamic fast-paced environment with fluctuating workloads
• Basic mathematical skills
• Intermediate typing skills
• Basic computer skills
• Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements
• Ability to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test

Nice To Haves

• Knowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred
• Knowledge of insurance policies, regulations, and best practices preferred

Responsibilities

• Should have Excellent Analytical skills to review claims based on rules and workflows.
• Need good comprehension skills to adjudicate claims as per Policies and Procedures.
• Should be a complete team player

What This Job Offers

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