Medical Claims Examiner
4 weeks ago
We are seeking a highly skilled Medical Claims Examiner to join our team at LHH Recruitment Solutions. As a Medical Claims Examiner, you will be responsible for processing medical and facility claims accurately and in a timely manner, ensuring all required information is included.
Key Responsibilities- Process medical and facility claims accurately and in a timely manner, ensuring all required information is included, such as accident details, subrogation forms, other insurance data, referrals, pre-certifications, repricing, and audits.
- Review provider reconsiderations and either reprocess the claim or generate response letters as needed.
- Address inquiries from coworkers or other departments via email or a ticketing system.
- Participate in check-run cycles and audits when assigned.
- Perform audits of auto-adjudicated claims and troubleshoot system configuration issues.
- Attend meetings with vendors, providers, and other partners as assigned.
- Monitor pended claims to avoid delays and maintain consistent processing times across plans.
- Correspond with providers, members, and external vendors via mail, email, or phone as necessary.
- Minimum of five (5) years of experience in medical PPO and HMO claims processing and health insurance.
- Meet or exceed 98% financial and 95% procedural standards for quality and production.
- Proficiency in medical claim processing, subrogation, ICD-10, CPT, HCPC Codes, HCFA 1500, and UB-02 claim forms.
- Strong knowledge of plan documents and insurance policies.
- Data entry experience.
- Basic computer and keyboarding skills.
We offer a competitive hourly rate of $24.00 to $26.00 per hour, as well as a comprehensive benefits package, including medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits, and a 401K plan.
We are an equal opportunity employer and welcome applications from qualified candidates with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements.
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Chicago, Illinois, United States LHH Recruitment Solutions Full time{"Job Title": "Medical Claims Examiner", "Job Type": "Temp to Hire", "Location": "Chicago, IL", "Work Schedule": "On-site, Monday to Friday, 37.5 hours per week", "Key Responsibilities": ["Process medical and facility claims accurately and in a timely manner", "Review provider reconsiderations and reprocess claims or generate response letters", "Address...
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