Medical Claims Examiner

TEKsystems•Sioux Falls, SD

11d•$24 - $27•Onsite

About The Position

Now Hiring for a Medical Claims Processor for a large healthcare organization in Sioux Falls, SD!! Description • Provide input to supervise or regarding ways to perform the position functions more effectively. • A quality performance should always be the Claims Examiner's goal while performing his/her job duties every day. • Review, analyze, evaluate, investigate and determine action on complex medical claims and apply necessary adjustment or refund as needed. • Perform detailed investigative procedures and determine the need for further development to resolve questions of eligibility, benefit liability, over utilization of services, and coding compliance initiatives. • Communicates through claims with members and providers to notify them of claim status and the need for additional information necessary to process claim. • Additional claims duties as required: preexisting conditions process, repricing of claims, claims adjustments, work with pharmacy claims, working with vendors for Letters of Agreement Entry of Authorizations received from vendors.

Requirements

1-3 years experience in medical insurance claim processing or medical insurance billing

Responsibilities

Provide input to supervise or regarding ways to perform the position functions more effectively.
Review, analyze, evaluate, investigate and determine action on complex medical claims and apply necessary adjustment or refund as needed.
Perform detailed investigative procedures and determine the need for further development to resolve questions of eligibility, benefit liability, over utilization of services, and coding compliance initiatives.
Communicates through claims with members and providers to notify them of claim status and the need for additional information necessary to process claim.
Additional claims duties as required: preexisting conditions process, repricing of claims, claims adjustments, work with pharmacy claims, working with vendors for Letters of Agreement Entry of Authorizations received from vendors.