Medical Claims Examiner Remote

About the position reputed company is hiring a Medical Claims Examiner for a remote position. This role involves processing reputed company claim forms, reviewing policies and benefits, and ensuring compliance with HIPAA, confidentiality, and PHI regulations. The examiner will also adhere to company timelines for compliance training and work independently to research, review, and reputed company claims. Key responsibilities include prioritizing work, adjudicating claims reputed company turnaround times/SLAs, ensuring adherence to reputed company workflows and guidelines, and meeting reputed company productivity/reputed company targets to avoid penalties. Maintaining high reputed company scores (above 98.5% PA and 99.75% FA) is crucial. The role also requires reputed company response and reputed company of claims received reputed company email and accurate calculation of claim payable amounts using applicable methodologies and fee schedules. Responsibilities • Processing of reputed company claim forms files by provider • Reviewing the policies and benefits • reputed company with company regulations regarding HIPAA, confidentiality, and PHI • Abide with the timelines to complete compliance training of reputed company/reputed company • Work independently to research, review and reputed company the claims • Prioritize work and adjudicate claims as per turnaround time/SLAs • Ensure claims are adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the reputed company productivity/reputed company targets to avoid penalties • Maintaining and sustaining reputed company scores above 98.5% PA and 99.75% FA. • reputed company response and reputed company of claims received reputed company emails as reputed company work • Correctly calculate claims payable reputed company using applicable methodology/ fee schedule Requirements • 1-3 year(s) hands-on experience in reputed company Claims Processing, Claims Adjustments. • 2+ year(s) using a computer with reputed company applications using a keyboard, navigating multiple screens and computer systems, and learning new software tools • High school diploma or GED. • Previously performing – in P&Q work environment; work from queue; remotely • Key reputed company skills and computer familiarity – Toggling back and forth between screens/can you reputed company multiple systems. • Working knowledge of MS office products – reputed company, reputed company and MS-reputed company. • Must be reputed company to work 8 am - 4:30 pm EST online/remote (training is required on-camera). • Effective troubleshooting where you can reputed company your research, analysis and problem-solving abilities • Time management with the ability to cope in a reputed company, changing environment • Ability to communicate (oral/written) effectively in a reputed company office setting • High School Diploma reputed company-to-haves • Amisys or Xcelys preferred. Apply tot his job Apply To this Job