OverviewHealth Insurance Medical Claims Examiner (Initial Training on Site - 30 days - Remote after training)SummaryThe Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines.Monday-Friday Schedule with daytime hoursResponsibilitiesEssential Duties and Responsibilities:
Reviews and adjudicates medical claims based on health policy provisions and established guidelines
Requests additional information from members and providers as needed
Initiates and completes claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits
Documents fully claims referred to senior staff for review and determination
Maintains company production and quality standards
Participates in training
Other Responsibilities:
Adheres to the policies and procedures of Premier Administrative Solutions
Maintains strict confidentiality of client, company and personnel information
Demonstrates a strong commitment to the mission and values of the organization
Adheres to company attendance standards
Performs other duties as assigned
Supervisory Responsibilities: NoneCompetencies:
Strong organizational and interpersonal skills
Excellent written and verbal communication skills
Detail oriented
Ability to multi-task and work independently
Knowledge of medical and dental coding systems
Knowledge of medical terminology
QualificationsQualifications:Minimum two (2) year of medical claims processing experienceEducation and/or Experience:Highschool diplomaor equivalent is requiredCertificates, Licenses, Registrations:NoneComputer Skills:Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and OutlookEnvironmental Factors/Physical Demands:Training is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping andlifting up to thirty (30) pounds.Job Locations US-FL-ClearwaterID 2024-2627# of Openings 4Category Medical Claims/Coding
