Claims - Claims Examiner
About The Position
This role involves managing and handling all outbound calls and adjudicating claims. The Claims Examiner will be responsible for adjudicating HP/AD claims and ensuring claims are processed according to client/company guidelines. The position requires independent work in researching, reviewing, summarizing, and recommending actions on claims. Strong English comprehension, mathematics, and medical science knowledge are essential for comprehending medical reports. The role also includes responding to and resolving claims received via email, calculating claim amounts accurately, and ensuring compliance with HIPAA and confidentiality regulations.
Requirements
- Strong English comprehension
- Mathematics knowledge
- Medical science knowledge
- Ability to comprehend medical reports
- Ability to work independently
- Ability to prioritize work
- Ability to calculate claim amounts
Responsibilities
- Manage and handle all Outbound calls
- Adjudicate HP/AD claims
- Prioritize work and adjudicate claims as per turnaround time
- Research, review, summarize, and recommend a course of action on claims
- Ensure claims are adjudicated as per the client/company guidelines
- Provide continual evaluation of processes and procedures
- Respond to and resolve claims received via emails
- Correctly calculate claim amounts for customers
- Comply with company regulations regarding HIPAA, confidentiality, and private health information
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
