Remote Health Insurance Claims Support Group Senior Claims Examiner

Job is Expired
Location: Alabama, Arizona, Connecticut, Florida, Georgia, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wyoming
Compensation: To Be Discussed
Staff Reviewed: Mon, Jul 18, 2022
Job Summary

A health insurance company is in need of a Remote Health Insurance Claims Support Group Senior Claims Examiner.

Core Responsibilities Include:

  • Reviewing and investigating claims and encounters for medical, facility, pharmacy, dental and vision services
  • Auditing and handling of specific claims and appeal requests
  • Identifying defects and improving departmental performance by supporting quality, operational efficiency and production goals

Qualifications Include:

  • High School Diploma or GED from an accredited institution
  • Experience identifying root cause claims adjudication process failures and ability to quantify departmental impact
  • Experience with the investigation, determination and reporting of claims processes\
  • Experience working with Excel spreadsheets
  • Experience standardizing reports across multiple sheets, utilizing VLOOKUPs & functions/formulas, creating, using/interpreting pivot tables, etc
  • Experience handling Personal Health Information (PHI) in a professional manner
COMPLETE JOB DESCRIPTION

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