Claims Examiner

Job Summary

A company is looking for a Claims Examiner-Product.

Key Responsibilities

• Review and analyze health care claims for cost reasonableness, medical necessity, and potential fraud
• Determine benefit levels for claims and negotiate discounts with providers
• Process claims in the QicLink System and document findings accurately

Required Qualifications, Training, and Education

• Minimum of 5 years of medical claims analysis experience, including dental and vision
• High School Diploma required; college and advanced degrees preferred
• Strong analytical skills and knowledge of computer systems and coding terminology (CPT and ICD-9)
• Continuing education in areas affecting group health and welfare plans is required
• Ability to work with computer-based programs for extended periods