Claims Examiner

SummaryJob DescriptionThe claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.Duties And Responsibilities Accurately review all incoming Provider claims to verify necessary information is available. Meets production standards of 100-150 claims as established by claims management Adjudicate claims in accordance with departmental policies and procedures and other rules applicable to specialty claims. Coordinate resolution of claims issues with other Departments. Assist Providers, Members and other Departments in claims research. Provide backup for other examiners within the Department. Assist in training of new claims personnel. Promote a spirit of cooperation and understanding among all personnel. Attend organizational meetings as required Adhere to organizational policies and procedures. Performs other tasks as assigned by supervisor/manager Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & CollaborationMinimum Job RequirementsHigh school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills. Ability to generate claims status reports and/or check runs.Skill And Abilities Experience in a managed care environment preferred. ICD-10 and CPT-4 coding knowledge preferred. Must be detail oriented and have the ability to work independently