Medical Claims Examiner
4 weeks ago
The Medical Claims Examiner will be responsible for ensuring claims are processed correctly and efficiently. This role requires a strong understanding of employee benefits and the ability to analyze data to determine the validity of claims.
Key Responsibilities:
- Compare claim data with internal policy and company records to ensure completeness and validity.
- Adjudicate medical claims and apply coordination of benefits as outlined in plan guidelines.
- Work with providers to gather necessary documents for final payment determination.
- Ensure all claims are coded properly.
- Examine Summary Plan Document and claim adjustors' reports to determine extent of coverage and liability.
Requirements:
- Associate's degree or equivalent from a two-year college or technical school.
- 3-5 years of experience in the employee benefits industry.
- Strong analytical skills and problem-solving abilities.
- Excellent written and verbal communication skills.
- Ability to work in a fast-paced environment and meet productivity standards.
About Us:
Benefit & Risk Management Services, Inc. is a leading benefit administrator and healthcare risk manager that delivers innovative technology and administration solutions to control rising healthcare costs.
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