Claims Examiner

5 days ago


Columbia, South Carolina, United States Spectraforce Technologies Full time
Job Title: Claims Processor II

Location: Columbia, SC

Duration: 11+ months assignment

Shift Timing: Mon-Fri 8am -4:30pm

Note: In-person interviews.

Job Summary

We are seeking a highly skilled Claims Processor II to join our team at Spectraforce Technologies. As a Claims Processor II, you will be responsible for reviewing and adjudicating complex or specialty claims, determining whether to return, deny or pay claims following organizational policies and procedures.

Key Responsibilities
  1. Examine and process complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
  2. Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.
  3. Verify that claims have been keyed correctly.
  4. Ensure that claims are processing according to established quality and production standards.
  5. Correct processing errors by reprocessing, adjusting, and/or recouping claims.
  6. Research and resolve claims edits and deferrals.
  7. Perform research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
  8. Respond to routine correspondence and completes spreadsheet if applicable.
Requirements
  • Strong organizational, analytical and judgment skills.
  • Strong oral and written communication skills.
  • Proficient in spelling, punctuation and grammar.
  • Proficient in basic business math.
  • Ability to handle confidential or sensitive information with discretion.
  • Required Software and Tools: Microsoft Office.
Preferred Qualifications
  • Strong time management skills.
  • Knowledge of mathematical and statistical concepts.
  • Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. Proficient database software skills.
Work Environment

Typical office environment.

Education and Experience

Required Education: High School Diploma or equivalent. Required Work Experience: 2 years of experience processing, researching and adjudicating claims. Preferred Work Experience: 5 years-of experience processing and adjudicating claims.


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