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Claims Examiner

3 months ago

Cincinnati, United States S&S Healthcare Full time
Job DescriptionJob Description

S&S Health is a premier healthcare administration company located in Cincinnati, Ohio. We offer self, level, and fully funded solutions that lower costs while improving outcomes with a consumer-centric experience. Our integrated benefits, services, and technology platform have been developed to serve the needs of Employers, TPAs, and Health Systems. The company has a nationwide presence with the ability to sell and service in every state.

This position is 100% remote working from your home

Medical Claims Examiners are responsible for the accurate and timely processing of claims, related correspondence, and must be extremely detail-oriented, precise and thorough. The Claims Examiner works both independently and in conjunction the Claims Team Manager to adjudicate claims, respond to provider or client inquiries in an accurate, timely and professional manner. We are looking for team players with excellent work ethic.

Minimum Qualifications:

· 5 years of experience in healthcare claims processing in a managed care and/or PPO/indemnity environment

· Extensive knowledge of medical terminology, HIPAA, standard claims forms (HCFA and UB) and physician billing coding

· Must have the ability to read/interpret contracts, standard reference materials (PDR, CPT, ICD-9, ICD-10, and HCPCS)

· Must have knowledge of Coordination of Benefits (COB).

· Must have strong analytical and problem-solving skills

· Previous EDI, Dental, Medicaid or Medicare claims processing is a plus.

· Must have excellent customer service skills

· Demonstrated ability to use Microsoft Word, Excel and Microsoft Outlook products

· High level of self-motivation, productivity and attention to detail; be well-organized; have excellent verbal and written communication skills

S&S Health are committed to creating a safe and secure workplace for all employees. Please note that all final candidates will be subject to a comprehensive background check as part of our hiring process.