Medical Claims Examiner

Overview

Health Insurance Medical Claims Examiner (Initial Training on Site – 30 days – Remote after training)

Summary

The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines.

Monday-Friday Schedule with daytime hours

Responsibilities

Essential Duties and Responsibilities:

Reviews and adjudicates medical claims based on health policy provisions and established guidelines

Requests additional information from members and providers as needed

Initiates and completes claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits

Documents fully claims referred to senior staff for review and determination

Maintains company production and quality standards

Participates in training

Other Responsibilities:

Adheres to the policies and procedures of Premier Administrative Solutions

Maintains strict confidentiality of client, company and personnel information

Demonstrates a strong commitment to the mission and values of the organization

Adheres to company attendance standards

Performs other duties as assigned

Supervisory Responsibilities: None

Competencies:

Strong organizational and interpersonal skills

Excellent written and verbal communication skills

Detail oriented

Ability to multi-task and work independently

Knowledge of medical and dental coding systems

Knowledge of medical terminology

Qualifications

Qualifications:

Minimum two (2) year of medical claims processing experience

Education and/or Experience:

Highschool diplomaor equivalent is required

Certificates, Licenses, Registrations:

None

Computer Skills:

Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook

Environmental Factors/Physical Demands:

Training is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping andlifting up to thirty (30) pounds.

Job Locations US-FL-Clearwater

ID 2024-2627

# of Openings 4

Category Medical Claims/Coding