Medical Claims Examiner

4 weeks ago


Greenville, United States BSI Companies Full time

ONSITE IN GREENVILLE, SC


Full Job Description 

BSI Companies is seeking a highly energetic, self-motivated candidate with previous experience in a TPA or medical insurance background. This candidate must be detailed-oriented. The Claims Examiner is responsible for processing medical, dental, vision and Flexible Spending claims in accordance with CMS and the member plan benefits. 


RESPONSIBILITIES: 

Performs through review of pended claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services. 

·        Corrects system generated errors manually prior to final claims adjudication. 

·        Process claims based upon the provider’s contract/agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and BSI policies and procedures. 

·        Alerts manager or supervisor of more complex issues that arise. 

·        Processes claim exception reports as assigned 

·        Maintain required levels of production and quality standards as established by management. 

·        Attendance at employer worksite is an essential job requirement. 

QUALIFICATIONS: 

· Preferred minimum of one year experience in medical claims processing, third party   administration or a self-pay claims processing system. 

· Current working knowledge of ICD-10, CPT, ADA, revenue codes and all applicable bill types. 

· Proficient with medical coding and terminology. 

·        Good verbal and written communication skills. 

·        Ability to work under pressure and adapt to changing environment. 

·        Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines. 

·        Proficient in Microsoft Office (Word, Excel, Outlook). 

·        Reliability and a strong work ethic are a must. 

Job Type: Full-time 

Schedule: 

·        8 hour shift 

Experience: 

·        Claims Processing: 1 year (Required) 

Location: Greenville, SC (Required) 



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