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 in relevant databases

Required Qualifications

• High School Diploma; College and Advanced Degrees preferred or equivalent work experience
• Minimum of 5 years of medical claims analysis experience, including dental and vision
• Strong analytical skills and knowledge of CPT and ICD-9 coding terminology
• Continuing education in areas affecting group health and welfare plans is required
• Must comply with applicable privacy and security laws, including HIPAA and HITECH