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Claims Examiner
Health Plans, Inc.Claims Examiner handling medical claims processing for HPI, ensuring compliance with plan benefits and maintaining client relationships.
About the role
Key responsibilities & impact- Process claims in accordance with plan benefits.
- Maintain minimum quality and production levels as determined by the Claims Manager.
- Maintain updated filings for claim benefit investigation (medical necessity reviews, etc.) as required in accordance with plan benefits.
- Prepare filings for outside vendors (subrogation) as required in accordance with the plan benefits.
- Handle correspondence from Plan Correspondent and/or employees in a timely and efficient manner.
- Resolve claim issues that do not require outside involvement.
- Serve as back-up to Customer Service department, as needed.
- Perform other various tasks that are deemed necessary and equitable by the Claims Manager
Requirements
What you’ll need- Ability to coordinate with management as effectively as with subordinates
- Ability to prioritize and multi task effectively
- Communicates effectively, both verbally and in writing
- Ability to work both independently and as a member of the team
- Ability to anticipate and understand systems interactions
- Must be detailed, analytical and accurate
- Recognize the need for follow-thru and follow-up
- Ability to work within specified timeframe and meet deadlines
- Recognize and maintain confidentiality of work materials as appropriate
- High School diploma or combination of education, related experience or training
- Prior claim processing experience desired
- Knowledge of medical terminology and/or billing & coding preferred
- Proficient with Microsoft Word and Excel or similar PC based programs
Benefits
Comp & perks- Medical, Dental and Vision and Prescription Drug Coverage
- Fitness Reimbursement Benefit
- Employee Assistance Program
- Flexible Spending Account & Health Savings Account
- 401(k) and Quarterly Bonuses
- Generous Paid-Time Off & Volunteering Opportunities
- Educational Assistance & Professional Development Opportunities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claim processingmedical terminologybillingcodingfiling preparationquality assuranceproduction levelsanalytical skillsaccuracysubrogation
Soft Skills
communicationcoordinationprioritizationmultitaskingindependenceteamworkattention to detailfollow-throughconfidentialitytime management
Certifications
High School diploma