Claims Examiner
Philadelphia, PA, United States
Job Description
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Your career starts now. We\xe2\x80\x99re looking for the next generation of health care leaders. At AmeriHealth Caritas, we\xe2\x80\x99re passionate about helping people get care, stay well and build healthy communities. As one of the nation\'s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we\xe2\x80\x99d like to hear from you. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Description:
The Claims Examiner reports to the Supervisor of Claims. The Claims Examiner is responsible for reviewing and adjudicating claims based on provider and health plan contractual agreements and claims processing guidelines.
Responsibilities:
- Complies with all internal processes and procedures to ensure activities are handled in accordance with departmental and company policies and procedures.
- Review, research, analyze, and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits).
- Escalates claim and/or system issues to Team Lead or Supervisor.
- Creates and supports a professional environment which fosters teamwork, cooperation, respect and diversity.
- Meet department quality and production requirements
- This position is required to meet and maintain performance goals established for the position in the areas of quality and production.
- Process claims for multiple Lines of Business as requested by management.
- Understands processing rules for multiple lines of business and supports other lines of business as needed to meet business needs.
Education/Experience:
- High School/GED required
- Associate\xe2\x80\x99s Degree preferred
- One to three years prior claims experience preferred
- Mathematical aptitude and analytical skills
- Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and leaning new computer programs.
- Ability to research and investigate information using multiple sources and documented guidelines
- Strong interpersonal skills
- Excellent listening, verbal and written communications skills
- Excellent comprehension, reasoning and decision making skills.
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Job Detail
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Job IdJD4253979
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IndustryNot mentioned
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Total Positions1
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Job Type:Full Time
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Salary:Not mentioned
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Employment StatusPermanent
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Job LocationPhiladelphia, PA, United States
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EducationNot mentioned