Working under the direction of the Claims Manager, you will be is responsible for examining commercial and/or hospital claims for plan members in a timely and accurate manner with attention to CMS guidelines and company policies.
Your daily role will be:
Processing EDI claims files by reviewing, coding and inputting data into information system
Assisting the Claims Manager or Assistant Supervisor in monitoring workflow for the claims processors
Working together in as a team to resolve complicated claim issues
Answering questions from other claims examiners.
Seeking a candidate with:
A couple years of experience in claims processing within a medical group or relevant experience in a insurance claims processing environment
Experience with commercial and senior claim processing, and be familiar with computerized claims
Processing/transaction system and medical coding (CPT, ICD9, HCPCS, DRG and APC)
High School Diploma or higher