Claims Examiner I, II or Sr
Posting Details
Job Details
Description
USAble Life has made Arkansas Business Magazine’s list of “Best Places to Work” for an impressive fifth consecutive year in a row! This, coupled with our engaging culture and a comprehensive benefits package, ensures we are committed to our employees.
Life Takes You Places!Are you ready to join us?
AClaims Examiner Iwill:
- Perform diverse duties relating to the processing, review and adjudication of claims; including reviewing for accuracy, file and claim completeness, reviewing coverage and approving payment or denial.
- Work in a training and learning capacity in conjunction with a more senior Claims Examiner until fully competent to independently receive claims documents.
- Communicate with claimants, group policy holders, medical providers and internal staff on claims related issues.
- Update tracking systems and processing systems as necessary.
Essential Duties:
- Review claim information for accuracy, completeness and coverage in force.
- Contacts claimants, group policyholders or medical providers for additional information.
- Compose and prepare correspondence to insureds, groups, beneficiaries and physicians.
- Analyze data and adjudicate claims in accordance with policy provisions.
- Maintain workload inventory on a daily basis. May perform other duties as assigned.
Required Knowledge, Skills, and Abilities:
- Knowledge of diagnosis and procedure codes and general medical terminology
- Proficient in MS Office
- Excellent verbal and written communication skills including professional telephone skills and the ability to compose professional correspondence
- Demonstrated leadership skills and the ability to assist and guide others
- Attention to detail and ability to maintain a low error rate
- Organization skills
- Ability to prioritize tasks, critical thinking, multi-task and handle deadlines.
Required Education and Experience:
- Associates degree or equivalent professional experience
- 1 to 3 years customer service experience
Preferred Education and Experience:
- Bachelor's Degree
- LOMA courses 280/281 and 290/291
- Medical coding experience
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AClaims Examiner IIwill:
- Update tracking systems and processing systems as necessary.
- Provides assistance and feedback to less experienced staff members as assigned.
Essential Duties:
- Reviews claims with increasing complexity information for accuracy, completeness and coverage in force.
- Contact claimants, group policyholders or medical providers for additional information.
- Compose and prepare correspondence to insureds, groups, beneficiaries and physicians.
- Perform claim file set-up.
- Enter information into claims processing system.
- Maintain workload inventory on a daily basis. May perform other duties as assigned.
Required Knowledge, Skills, and Abilities:
- Knowledge of diagnosis and procedure codes and general medical terminology
- Proficient in MS Office
- Excellent verbal and written communication skills and ability to compose professional
correspondence
- Demonstrated leadership skills and the ability to assist and guide others
- Attention to detail and ability to maintain a low error rate
- Organization skills
- Ability to prioritize tasks, critical thinking, multi-task and handle deadlines
Required Education and Experience:
- Associates Degree or Equivalent professional experience
- 1 to 3 years customer service experience
- 1 to 3 years as a Claims Examiner
Preferred Education and Experience:
- Bachelor's Degree
- LOMA courses 280/281 and 290/291
- Experience with FINEOS or other claims system
__________________________________________________________________
AClaims Examiner Sr.will:
- Provide prompt resolution to internal and external customers, clients, and group administrators with escalated issues related to claims in clear, concise verbal and written communications.
- Provide mentoring and coaching in problem resolutions to other team members as well as training new employees.
- Update tracking systems and processing systems as necessary.
- Provide assistance and feedback to less experienced staff members as assigned.
Essential Duties:
- Review claims with the most complexity for information for accuracy, completeness and coverage in force.
- Contact claimant, group policyholder or medical provider for additional information.
- Analyze data and adjudicate claims in accordance with policy provisions.
- Compose and prepare correspondence to insureds, groups, beneficiaries and physicians.
- Provide mentoring and coaching to other team members and new employees.
Required Knowledge, Skills, and Abilities:
- Knowledge of diagnosis and procedure codes and general medical terminology
- Proficient in MS Office
- Excellent verbal and written communication skills and ability to compose professional
correspondence
- Demonstrated leadership skills and the ability to assist and guide others.
- Attention to detail and ability to maintain a low error rate
- Organization skills
- Ability to prioritize tasks, critical thinking, multi-task and handle deadlines.
Required Education and Experience:
- Associates Degree or equivalent professional experience; LOMA 280/281 and 290/291within 18 months of hire to position
- 3 to 5 years claims experience
Preferred Education and Experience:
- Bachelor's Degree in a business related field; LOMA courses 280/281 and 290/291
- 3 or more years of insurance industry experience; experience with FINEOS or other claims system
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