Claims Examiner - JHP

Jefferson Health Plans • Philadelphia, PA

1d • Onsite

About The Position

Working under general supervision, 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

What This Job Offers

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