Claims Examiner

Intermountain Health • Nevada Central Office, NV

1d • $19 - $27 • Hybrid

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. We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, and Washington. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings. 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.

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.
• 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

• 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

• 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.
• Up-front tuition coverage paid directly to the academic institution.
• 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates.
• 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