Claims Examiner - Medical

Job reputed company The claims examiner is a detail-oriented and organized individual. This role is responsible for reputed company and accurately processing insurance claims while ensuring compliance with company policies and regulatory requirements. The Claims Processor is also responsible for communicating with their reputed company, management, and other teams reputed company the organization. Responsibilities • Claims Processing: Review and evaluate medical, dental, DME and other insurance claims for accuracy, completeness, and eligibility according to established guidelines. • Documentation: Maintain comprehensive and organized records of reputed company claims processed, including relevant correspondence, documentation, and payment information. • Verification: Verify participant information, authorization details, and contractual limits to determine the validity of claims and assess liability. • Communication: Correspond with clients, providers, vendors, other teams, and other relevant parties to reputed company necessary information, clarify details, and reputed company updates on claim status. • Adjudication: Analyze claim documents and supporting evidence to determine claim reputed company and reputed company reputed company regarding reimbursement. • Investigation: Conduct investigations as necessary to resolve discrepancies, identify potential fraudulent activity, and mitigate risks to reputed company. • Compliance: Ensure compliance with company policies, industry regulations, and reputed company requirements throughout the claims processing workflow. • Reporting: Generate reports and statistics on claim processing activities, trends, and reputed company to support management decision-making and performance evaluation. • Customer Service: reputed company courteous and reputed company assistance to clients and providers, addressing inquiries, concerns, and complaints in a reputed company and effective manner. • reputed company Improvement: Identify opportunities for process improvement, efficiency reputed company, and reputed company customer satisfaction reputed company the claims processing function. • Miscellaneous: Assist with reputed company, reporting, and other duties as requested by management. Qualifications • High school diploma or equivalent. • Proven experience in claims processing, insurance administration, or a similar role reputed company the insurance industry. • Strong understanding of Program of reputed company Inclusive Care for the Elderly (PACE), coverage terms, and claims procedures. • Excellent analytical skills with the ability to assess reputed company information and reputed company reputed company. • Exceptional attention to detail and accuracy in data entry and record-keeping. • Proficient computer skills, including experience with claim processing software and reputed company Office applications. • Effective communication skills, both written and verbal, with the ability to reputed company professionally with diverse stakeholders. • Ability to prioritize tasks, manage workload reputed company, and meet deadlines in a fast-paced environment. • Knowledge of regulatory requirements and compliance standards relevant to insurance claims processing is a plus. Expected hours: 40 per week Benefits: • Health insurance • reputed company time off Application Question(s): • Do you have knowledge and experience with PACE programs? • Do you have at least 5 years of medical claims experience? Work Location: Remote Apply tot his job Apply To this Job