Medical Claims Examiner Trainee

2 weeks ago


Mercer Island, United States WPAS Full time
Responsibilities:
* Learn to request information to complete or review claims using standard procedures and letters, and asks questions as needed.
* Must demonstrate ability to learn and grow with continuous improvement and ability to increase average daily claim production while maintaining accuracy and quality.
* Performs computations and processes claims independently up to the dollar threshold set by the trainer not to exceed the job classification maximum of $1,500.00.
* Learns to perform duties and prepare to become a Claims Examiner by meeting training objectives and expected production metrics.
* Communicates efficiently by telephone, in writing or in person with all personnel, members, providers, external vendors or others regarding claim benefit questions or information.
* Communicates with the Quality Assurance Supervisor in conjunction with their trainer as necessary to request and receive data on pending claims.
* Learns to apply procedures to third-party liability claim claims.
* Exercises professional judgment on daily tasks and seeks approval from supervisor or trainer when faced with new or unfamiliar tasks.
* Maintain a 10 business-day turnaround time on assigned claim responsibilities.
* Maintain and update a pending file with follow-ups on correspondence as required.
* Ability to meet production and quality goals on a consistent basis as outlined within training.
* Routes claims requiring review to the assigned Claim Adjuster Senior II.
* Demonstrates knowledge of assigned duties as well as the legacy and the recently migrated claims processing system.
* Perform other duties as assigned.
* Minimum qualifications:

Minimum qualifications:
* 6 months or more within a Claims Pre-Processor position Or
* 6 months in another position with field related experience.
* Working knowledge of basic office equipment.
* Positive interpersonal communications with internal personnel, external clients and vendors.
* Demonstrated ability to keep calm and positive within all communications.
* Proven ability to accurately and timely review and edit documents.
* Utilize computer, phone systems and reference materials to be able to effectively perform the essential functions of the position.
* Previous experience utilizing Microsoft office software.
* High school diploma or G.E.D

Job Type: Full-time

Pay: From $19.87 per hour

Expected hours: 40 per week

Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* Monday to Friday

Application Question(s):
* Do you have at least 1 year of medical/dental claims ?
* What state do you live in?

Work Location: In person

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