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Senior Claims Analyst

2 months ago

Coral Gables, Florida, United States DOCTORS HEALTHCARE PLANS, INC. Full time

The Claims Examiner III plays a crucial role in ensuring that claims are evaluated in accordance with departmental protocols while supporting the Claims Manager in optimizing workflow and processes to meet established objectives.

Key Responsibilities:

  • Assess and authorize both professional and institutional claims
  • Handle Member Reimbursement claims efficiently
  • Collaborate with the Assistant Director to address weekly and monthly workflow challenges and set departmental targets
  • Assist the Assistant Director in compiling reports to monitor productivity and outstanding items
  • Engage in the implementation of departmental policies and procedures
  • Work alongside the Assistant Director to ensure the team achieves production and quality benchmarks
  • Effectively communicate strategies to enhance performance and meet defined objectives to department staff
  • Foster a supportive environment that promotes staff well-being and encourages teamwork
  • Ensure optimal utilization of system capabilities by the team
  • Perform additional duties as required
Qualifications:
  • High School diploma or GED
  • Minimum of 3 years experience as a Medical Claims Examiner
  • Proficient in contract interpretation
  • Competent in using Windows and other relevant software applications
  • Able to collaborate effectively with colleagues
  • Familiarity with CMS guidelines and regulations

Note: This description provides a general overview of the type and level of work performed and responsibilities held by team members. The duties outlined are not exhaustive or specific to any individual team member.

Our organization is dedicated to fostering a diverse workplace. All qualified candidates will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Opportunities listed here do not establish any implied or express employment contract between you and our organization or our clients and may be modified at our discretion and/or the discretion of our clients. Any and all information may change without prior notice. We reserve the right to determine applicant suitability independently. By submitting your application, you agree to all terms outlined herein.