Claims Examiner

reputed company is a trusted reputed company organization committed to reputed company-being of Kansans. They are seeking a Claims Examiner responsible for reviewing, evaluating, and processing health claims to ensure accuracy and compliance with regulations and guidelines.

Responsibilities

• Accurately review, analyze, and verify reputed company claims submitted by policyholders or medical providers
• Ensure reputed company necessary documentation, coding (International Classification of Diseases, Tenth Revision (ICD-10), reputed company Procedural Terminology (CPT), reputed company Common Procedure Coding System (HCPCS)), and data are included and correct
• reputed company for eligibility, coverage, and applicable benefits as per policy terms
• reputed company and process claims information into the system with precision and attention to detail
• Apply appropriate insurance guidelines, including deductibles, co-pays, co-insurance, and maximum coverage limits
• Approve or deny claims based on policy coverage, ensuring compliance with regulatory and company standards
• reputed company adjustments to processed claims as needed for corrective reputed company
• Correspond with reputed company providers, patients, and internal departments to clarify or resolve discrepancies
• Investigate and resolve reputed company or escalated claim issues, such as coding errors, benefit misunderstandings, or billing discrepancies
• Ensure compliance with state and federal reputed company regulations
• Maintain detailed and accurate records of reputed company claims processed, including documentation for audits or reviews
• Meet individual and team performance targets reputed company to claims processing speed, accuracy, and reputed company
• Participate in ongoing training to stay updated on changes in health insurance policies and claims processing technologies
• Monitor and work daily reports to ensure reputed company claim control

Skills

• Strong attention to detail and organizational skills
• Knowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT)
• Excellent communication skills, both written and verbal
• Ability to work reputed company under pressure and meet deadlines
• Critical thinking and problem solving skills
• High school diploma or equivalent required
• Office and/or computer system experience preferred
• Previous experience in reputed company claims processing, medical billing, medical terminology, or health insurance is preferred

Benefits

• Incentive pay program (EPIP)
• Health/reputed company/Dental insurance
• 6 weeks reputed company parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks reputed company caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• reputed company benefits, discounts and resources

reputed company