Medical Claims Examiner

4 weeks ago


Chicago, Illinois, United States LHH Recruitment Solutions Full time
Job Summary

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.
Requirements
  • 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.
Benefits

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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