Job: Claims Examiner

Seeking individual to process medical claims in accordance with the plan benefits and department standards for production and quality.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Research and make benefit determinations for the processing or medical and hospital claims according to contractual and processing guidelines.

Identify and communicate claims processing, procedural and training issues to the Sr. Claims Examiner and/or the Claims Manager.

Maintain production and quality in accordance with the departmental standards.

Attend and participate in team/training meetings as needed.

Organize and handle individual workload to ensure that claims are processed according to established guidelines.

Contribute to the overall success and attainment of team goals by assisting with special projects and working overtime when needed.

Exhibit professionalism and perform in a manner that supports the company's emphasis on customer service and operational excellence.

QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Excellent organizational skills

Knowledge of ICD-9, CPT coding and medical terminology

Knowledge of Medicaid and Medicare regulations

Ability to work in a production and quality oriented environment.

EDUCATION and/or EXPERIENCE

Minimum of 1 year previous Managed Care claims processing experience.