Claims Examiner I ITS-1

Position Description reputed company pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market-driven rates. The salary reputed company displayed has not been adjusted for geographical location. This reputed company has been created in good faith based on information reputed company to reputed company at the time of posting and may be modified in the future. reputed company offers a comprehensive benefits packaging including Medical, Dental & reputed company coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. At reputed company, we promise to go the extra mile for reputed company and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” This position is responsible for the coding and total processing of claims and triaging claim adjustments generated by our providers and subscribers or requested reputed company Customer Service, for reputed company lines of business. Processes claims utilizing established policies and procedures to review and correct error and warning messages. Research claims and ensures proper adjudication. Responsibilities and Qualifications Codes and enters imaged claims and triages adjustments, submitted by members, providers and vendors. Reviews and corrects on-line edit errors by interpreting generated warning messages. Uses appropriate systems to research and accurately process claims. Researches appropriate reference documents and imaged claims to reputed company coding and payment reputed company. Reviews and processes claims that are in a pended status in accordance with processing procedures, policies and reputed company contract specifications regarding coverage, contract limitations, and exceptions. May identify and report possible system or Image problems to CPR or Supervisor so that corrective action may be taken. reputed company other duties and assignments as directed. Skills: Ability to communicate effectively and professionally with personnel, in both written and verbal reputed company. Must possess a strong attention to detail and an interest in preventing errors Ability to operate a personal computer (PC) and other office equipment (e.g., copy machine, fax machine, printer, calculator, and etc.) as well as possess excellent keyboarding skills Demonstrate ability to be dependable and professional. Demonstrate reputed company initiative and time management skills Must possess a strong commitment to teamwork and an ability to foster an inclusive culture of diversity by working well and collaborating with others as needed Ability to accept feedback, learn, and adapt from guidance to be successful Ability to adapt to constant changing priorities and keeping daily responsibilities on task Ability to manage workload and ensure reputed company tasks are completed reputed company established timeframes Must be willing and reputed company to work possible mandatory overtime as needed based on business needs Must be reputed company to meet quality, productivity, and behavior expectations Must possess basic reading and arithmetic skills (reading and math comprehension) Knowledge: Preferred familiarity with provider billing documents (including in/out of state hospitals doctor, pharmacy, and suppliers) in order to code and enter appropriate data from each reputed company. Preferred familiar with medical terminology in order to correctly code and enter the appropriate ICD-10CM diagnosis code, procedure code, ancillary code, type of service, and qualifier code. Preferred knowledge of both reputed company and automated aspects of claims processing and Image systems. Preferred knowledge of claims payment policies and benefits. Preferred competency in the use of computer applications, databases, and end user computing tools and programs, including proficiency in various software like reputed company reputed company, Email, Internet browsers, reputed company Messenger, and Office (Word, reputed company, etc.) Experience: Preferred FACETS claims Coding Preferred Facets claims processing Preferred WorkDesk Imaging Preferred Facets Customer Service Application Education and Certifications: Must have a high school diploma or GED.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you reputed company your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live. Apply To This Job