Claims Investigator-Examiner
About The Position
The Claims Department is a dynamic department that provides claims examination and adjudication for the organization’s multiple health plans and AHF grants and contracts. The Claims Investigator-Examiner contributes to AHF's mission by ensuring accurate and timely and payment of claims and providing a positive experience to providers and internal staff. Reliability in the handling of claims ensures internal/external providers’ satisfaction and high retention rates. The Claims Investigator-Examiner enhance the experience of providers and the organization by being knowledgeable, friendly, and helpful and by offering accurate and thorough responses or instructions to enquiries about claims. The Claims Investigator-Examiner contributes to the success of the organization by maintaining a thorough understanding of the organization’s health plans eligibility, benefits, and procedures while keeping abreast of various contractual, regulatory, compliance, and quality standards as related to claims review, processing and payment. The Claims Investigator-Examiner’s attention to detail, analytic capabilities, and excellent customer service play a large role in the Plan’s overall success.
Requirements
- Attention to detail
- Analytic capabilities
- Excellent customer service skills
Responsibilities
- Ensuring accurate and timely payment of claims.
- Providing a positive experience to providers and internal staff.
- Being knowledgeable, friendly, and helpful in responding to inquiries about claims.
- Offering accurate and thorough responses or instructions to inquiries about claims.
- Maintaining a thorough understanding of the organization’s health plans eligibility, benefits, and procedures.
- Keeping abreast of various contractual, regulatory, compliance, and quality standards as related to claims review, processing and payment.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
