Claims Examiner - Jefferson Health Plan

Thomas Jefferson University•Philadelphia, PA

10d•Onsite

About The Position

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

medical (including prescription)
supplemental insurance
dental
vision
life and AD&D insurance
short- and long-term disability
flexible spending accounts
retirement plans
tuition assistance
voluntary benefits
tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service