Senior Claims Examiner
3 weeks ago
- 1st shift opportunity – Monday to Friday from 8:30am-4pm
- Competitive hourly wage at $27/hr.
- Contract to hire position - you'll be hired in by our client based on performance and business needs
- Benefit package available once hired on with client
- Medical, Dental, Vision
- Life Insurance
- EAP
- Process claims for society members including medical, dental, vision, and prescription.
- Deal with complex claim issues and identifying root cause of problems
- Understand and analyze insurance EOB's to ensure maximum cost savings from plans.
- Requests additional information for incomplete claims and follow up with provider as necessary.
- Handle insurance enrollments as well as Social Security and other government benefits.
- Maintain database containing data on insurance, Social Security, and medical device coverage.
- Supervise Claims Examiners in absence of Claims Supervisor and/or Director.
- Audit claims processed by Claims Examiners and Claims Assistant.
- Assist the Claims Supervisor with all unit initiatives including check runs, cost containment, and special projects.
- High school diploma or equivalent; some college preferred
- 3+ years' experience in medical claims processing
- Must have working knowledge, compliance and understanding of HIPAA guidelines, ICD-10, CPT, ADA, HCPCS codes, medical terminology and familiarity with various health claims and forms including HCFA/CMS-1500, UB-04, and ADA forms.
- Knowledge and understanding of various medical and prescription drug insurance plans including Medicare, Medicaid, HMO's, PPO's, and Government Plans
- Self-starter able to work in a highly accurate, independent and organized, efficient manner
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