Claims Examiner

Intermountain Health

1d • $19 - $27

About The Position

The Claims Examiner I is responsible for inbound calls from providers and health plans and adjudicates physician claims, in a timely and accurate manner. Provides superior customer service consistent with company standards and goals, including inbound calls from providers and health plans. Responsible for quality and continuous improvement within the job scope. Also responsible for all actions/responsibilities described in company-controlled documentation for this position. Contributes to and supports the corporation’s quality improvement efforts. Processes medical claims (CPT, ICD, and Revenue Coding) at production standards, including timely follow-up on inquiries received and correctly logs all incoming calls and emails. Maintains the minimum accuracy standard and follows up timely to meet compliance standards for claims, pends, and tasks. Reviews claim images and batches to ensure accuracy. Uses proper plan documentation to determine benefits and correctly adjudicate. Meets and maintains the minimum production in addition to completing reports and projects given by the supervisor. Effectively participates in meetings, training, and committees as designated by the supervisor. Reviews feedback from supervisors, trainers, auditors, examiners, and trending spreadsheets. Identifies and implements required steps for improvement. The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor. All positions subject to close without notice. Thanks for your interest in continuing your career with our team!

Requirements

• One year of claims processing, claims logging, or customer service experience in a managed care environment.
• Demonstrated minimum of 100 SPM on ten key and 30 WPM typing.

Nice To Haves

• Associates degree or some college level coursework. Degree obtained from accredited institution. Education is verified.
• Demonstrated excellent verbal, written, and interpersonal skills.
• Demonstrated consistent accuracy and processing efficiency in work.
• Demonstrated ability to resolve complex claims problems and be detailed oriented.
• Manual dexterity, hearing, seeing, speaking.

Responsibilities

• Responsible for inbound calls from providers and health plans and adjudicates physician claims, in a timely and accurate manner.
• Provides superior customer service consistent with company standards and goals, including inbound calls from providers and health plans.
• Responsible for quality and continuous improvement within the job scope.
• Responsible for all actions/responsibilities described in company-controlled documentation for this position.
• Contributes to and supports the corporation’s quality improvement efforts.
• Processes medical claims (CPT, ICD, and Revenue Coding) at production standards, including timely follow-up on inquiries received and correctly logs all incoming calls and emails.
• Maintains the minimum accuracy standard and follows up timely to meet compliance standards for claims, pends, and tasks.
• Reviews claim images and batches to ensure accuracy.
• Uses proper plan documentation to determine benefits and correctly adjudicate.
• Meets and maintains the minimum production in addition to completing reports and projects given by the supervisor.
• Effectively participates in meetings, training, and committees as designated by the supervisor.
• Reviews feedback from supervisors, trainers, auditors, examiners, and trending spreadsheets.
• Identifies and implements required steps for improvement.

Benefits

• We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
• Learn more about our comprehensive benefits package here.
• Intermountain Health’s PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree