Claims Hmo Claims Examiner 140 1028
Tulsa, OK 74119, United States
Job Description
b'
JOB SUMMARY: The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency. KEY RESPONSIBILITIES: \xe2\x80\xa2 Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making in determining appropriate actions.
- Identify claims requiring additional resources and route to the team lead, supervisor or other departments as needed. \xe2\x80\xa2 Enter claims information using the processing software to compute payments, allowable amounts, limitations, exclusions and denials. \xe2\x80\xa2 Identify and communicate trends or problems identified during adjudication process. \xe2\x80\xa2 Contribute to the creation of a pleasant working environment with peers and other departments.
- Assist in investigating and solving claims that require additional research. \xe2\x80\xa2 Consistently learn and adapt to changes related to claims processing, benefits, limits and regulations. \xe2\x80\xa2 Perform other duties as assigned. QUALIFICATIONS: \xe2\x80\xa2 Self-motivated and able to work with minimal direction.
- Ability to read and understand claims processing manuals, medical terminology, CPT codes, and perform basic processing procedures. \xe2\x80\xa2 Ability to read and understand health benefit booklets. \xe2\x80\xa2 Demonstrated learning agility. \xe2\x80\xa2 Successful completion of Health Care Sanctions background check.
- Knowledge in the contracted managed care plan terms and rates. \xe2\x80\xa2 General understanding of unbundling methods, COB, and other over-billing methodologies. \xe2\x80\xa2 Must have high attention to detail. \xe2\x80\xa2 Proficient in Microsoft applications.
- Ability to perform basic mathematical calculations. \xe2\x80\xa2 Possess strong oral and written communication skills. EDUCATION/EXPERIENCE: \xe2\x80\xa2 High School Diploma or Equivalent required. \xe2\x80\xa2 Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.
Beware of fraud agents! do not pay money to get a job
MNCJobz.com will not be responsible for any payment made to a third-party. All Terms of Use are applicable.
Related Jobs
-
-
Workers Compensation Claims Examiner III _Temp_ New York
Philadelphia, PA 19107 -
Job Detail
-
Job IdJD4254681
-
IndustryNot mentioned
-
Total Positions1
-
Job Type:Full Time
-
Salary:Not mentioned
-
Employment StatusPermanent
-
Job LocationTulsa, OK 74119, United States
-
EducationNot mentioned