Claims Examiner

Health Plans Inc•Remote, US,

10h•$21 - $25•Onsite

About The Position

HPI is a unique, respected industry leader that has been serving customers for over 44 years, known for its innovation and adaptability. As a third-party administrator, HPI offers a suite of health and benefit solutions to employers. Joining HPI means contributing to ideas that make a real difference for employers and employees nationwide. The company fosters a supportive and inclusive work environment where innovation thrives, investing in the team's growth and well-being to ensure exceptional service. The Claims Examiner is responsible for processing medical claims in accordance with applicable plan benefits, handling a specific block of group plans, and maintaining client/customer relationships. The role involves assisting claimants, providers, and clients with claim and policy-related issues, and all Claim Examiners are required to successfully complete a training session approved by the Claims Manager.

Requirements

Ability to coordinate with management as effectively as with subordinates
Ability to prioritize and multi task effectively
Communicates effectively, both verbally and in writing
Ability to work both independently and as a member of the team
Ability to anticipate and understand systems interactions
Must be detailed, analytical and accurate
Recognize the need for follow-thru and follow-up
Ability to work within specified timeframe and meet deadlines
Recognize and maintain confidentiality of work materials as appropriate
High School diploma or combination of education, related experience or training
Proficient with Microsoft Word and Excel or similar PC based programs

Nice To Haves

Prior claim processing experience desired
Knowledge of medical terminology and/or billing & coding preferred
Experience working in the healthcare industry

Responsibilities

Process claims in accordance with plan benefits.
Maintain minimum quality and production levels as determined by the Claims Manager.
Maintain updated filings for claim benefit investigation (medical necessity reviews, etc.) as required in accordance with plan benefits.
Prepare filings for outside vendors (subrogation) as required in accordance with the plan benefits.
Handle correspondence from Plan Correspondent and/or employees in a timely and efficient manner.
Resolve claim issues that do not require outside involvement.
Serve as back-up to Customer Service department, as needed.
Perform other various tasks that are deemed necessary and equitable by the Claims Manager.