Claims examiner

Claims Examiner
UST HealthProof is looking for Claims Examiner, reporting to the Claims Team Leader, the Examiner is responsible for adjudication of healthcare claims utilizing employer and payer specific policies and procedures. Responsible for reviewing the data in the claims processing system and compare with corresponding UB04 or CMS1500. Responsible for reviewing claims attachments when necessary to determine if services rendered was medically appropriate and benefit coverage criteria has been met. Responsible for reviewing adjudication software systems claim and line items edits for determination of whether to pay claim/line item(s).
As a Claims Examiner at UST HealthProof, this is your opportunity to
Be responsible for attending and successfully completing the trainings scheduled by the client and employer
Be responsible for processing assigned claims based on client specified guidelines or as directed by team lead
Be responsible for meeting claims productivity targets of claims per hour or day as set by team lead
Collaborate with other team members on special projects as assigned by the team leads including process documentation, training, quality audit, assist with surge activity for client (s), or any other project as determined by the team lead
Develop Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9 and ICD-10, UB04, CMS 1500, authorization and other terms, terminology and concepts of healthcare
Develop some level of communication with client Claims managers to address issues, concerns and take preventive measures to avoid service quality issues
Be responsible for your attendance, time off and reporting shift timings etc. with the prime objective of meeting and exceeding customer deliverables
Participate in meetings and project activities outside of the primary location at locations determined by UST management team and team lead
You bring:
High School degree required with one year of relevant professional experience in Healthcare claims operations for an insurance company or healthcare payor.
Willingness to learn new skills and succeed in a new career
Excellent verbal and written communication skills.
Proficiency with MS Office applications, especially Word and Excel.
Team collaborator
ICD-9 and ICD-10 coding is a plus, CPT and HCPCS coding, HIPAA is a plus
Strong work ethic with ability to multi-task is essential
High proficiency in using MS Excel and MS Office Suite
Good understanding and ability to analyze claims data and report, SLA, KPI, operations report and present findings in a structured way
For this role, we value:
The ability to adapt quickly to a fast-paced environment, self-starter and quick learner
Excellent written and oral communication skills
Team Player and ability to collaborate
Overall Experience level: 0-2 years of operation experience, any healthcare
UST Global celebrates diversity and inclusion. We are an Equal Employment Opportunity employer. We welcome candidates to apply for employment from diverse backgrounds and believe your unique perspective adds to the richness of our company culture. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.