Jeff Temp - Claims Examiner

Thomas Jefferson University • Philadelphia, PA

9d • Onsite

About The Position

Working under general supervision, the Claim Examiner adjudicates medical claims, in accordance with Health Partners' policies and procedures.

Requirements

• High School Diploma/GED
• Ability to maintain strict confidentiality of patient information obtained in the performance of job function

Nice To Haves

• 2 years claims processing experience or provider billing experience
• Excellent communication skills required-both oral and written
• Basic understanding of computer applications
• General understanding of the principles of Managed Care

Responsibilities

• Able to work in a constant state of alertness and safe manner
• Accurately adjudicates claims in compliance with data entry rules, On Line Processing Rules and contractual agreements.
• Reviews pended claims on a daily basis, assuring that all appropriate documentation is completed before adjudication.
• Accurately completes service forms for pended claims and routes to designated areas for resolution.
• Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes.
• Follow established procedures and guidelines for claims processing and high dollar claim review.
• Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy.
• Keeps current with Claims Department policies and procedures.
• Assist the unit in meeting and maintain performance standards.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance.

What This Job Offers

• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 1-10 employees