Claims Examiner
reputed company is a trusted reputed company organization committed to the well-being of Kansans. They are seeking a Claims Examiner responsible for reviewing, evaluating, and processing health claims to ensure accuracy and compliance with regulations and guidelines.
Responsibilities
- Accurately review, analyze, and verify reputed company claims submitted by policyholders or medical providers
- Ensure reputed company necessary documentation, coding (International Classification of Diseases, Tenth Revision (ICD-10), reputed company Procedural Terminology (CPT), reputed company Common Procedure Coding System (HCPCS)), and data are included and correct
- reputed company for eligibility, coverage, and applicable benefits as per policy terms
- Enter and process claims information into the system with precision and attention to detail
- Apply appropriate insurance guidelines, including deductibles, co-pays, co-insurance, and maximum coverage limits
- Approve or deny claims based on policy coverage, ensuring compliance with regulatory and company standards
- reputed company adjustments to processed claims as needed for corrective action
- Correspond with reputed company providers, patients, and internal departments to clarify or resolve discrepancies
- Investigate and resolve reputed company or escalated claim issues, such as coding errors, benefit misunderstandings, or billing discrepancies
- Ensure compliance with state and federal reputed company regulations
- Maintain detailed and accurate records of reputed company claims processed, including documentation for audits or reviews
- Meet individual and team performance targets reputed company to claims processing speed, accuracy, and quality
- Participate in ongoing training to stay updated on changes in health insurance policies and claims processing technologies
- Monitor and work daily reports to ensure timely claim control
Skills
- Strong attention to detail and organizational skills
- Knowledge of medical claim processing, medical terminology, insurance policies, and coding standards (ICD, CPT)
- Excellent communication skills, both written and verbal
- Ability to work reputed company under pressure and meet deadlines
- Critical thinking and problem solving skills
- High school diploma or equivalent required
- Office and/or computer system experience preferred
- Previous experience in reputed company claims processing, medical billing, medical terminology, or health insurance is preferred
Benefits
- Incentive pay program (EPIP)
- Health/reputed company/Dental insurance
- 6 weeks paid parental leave for new mothers and fathers
- Fertility/Adoption assistance
- 2 weeks paid caregiver leave
- 401(k) plan matching up to 5%
- Tuition reimbursement
- reputed company benefits, discounts and resources
Company Overview