JeffTemp - Claims Examiner

Jefferson Health Plans • Philadelphia, PA

17h • Onsite

About The Position

Working under general supervision, the Claim Examiner adjudicates medical claims, in accordance with Health Partners' policies and procedures. This role involves accurately adjudicating claims in compliance with data entry rules, On Line Processing Rules, and contractual agreements. The examiner reviews pended claims daily, ensuring all appropriate documentation is completed before adjudication, and accurately completes service forms for pended claims, routing them to designated areas for resolution. Weekly audit results are reviewed, and errors in the claims processing system are corrected within designated timeframes. The position requires following established procedures and guidelines for claims processing and high dollar claim review, maintaining minimum performance standards for claim production and accuracy, and staying current with Claims Department policies and procedures. The examiner also assists the unit in meeting and maintaining performance standards. The role requires the ability to work in a constant state of alertness and in a safe manner, and to maintain strict confidentiality of patient information.

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

• Medical (including prescription) insurance
• Supplemental insurance
• Dental insurance
• Vision insurance
• Life and AD&D insurance
• Short- and long-term disability
• Flexible spending accounts
• Retirement plans
• Tuition assistance
• Voluntary benefits, which provide colleagues with access to group rates on insurance and discounts
• Tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• Medical (including prescription) insurance for all colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps)

What This Job Offers

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