Claims Examiner

JOB SUMMARY

• Run report for all possible duplicate and process accordingly.
• Run reports daily to process COB’s and Reversals timely.
• Review overpayment request letters and process retractions once received
• Make sure all claims that are due for weekly check run are ready for payment.
• Performed all other duties as assigned by Director of Claims/Supervisor.

QUALIFICATIONS

• Minimum three (3) years of claims processing experience in the health insurance industry or medical health care delivery system.
• Work independently as part of a team
• Strong organization skills: ability to multitask and properly manage time
• Preferred knowledge of Medicare and Commercial rules and regulations
• Must have an understanding to read and interpret DOFRs and Contracts
• Must understand how to read a CMS-1500 and UB-04 form

SKILLS

• Must have effective communication, facilitation, interpersonal and professional diplomacy skills.
• Strong attention to detail with ability to manage multiple priorities while meeting deadlines.
• Able to Problem-solve, negotiate and demonstrate independent decision-making.
• Strong communication skills in both oral and written form.
• Positive attitude and takes teams approach to management.
• Maintain strong skills in diplomacy, professionalism and trustworthiness.
• Familiarity with Microsoft applications, which include the ability to learn new computer systems and applications.
• Ability to manage multiple priorities and projects.
• Detail oriented with desire for producing work with 100% accuracy.
• Excellent analytical and problem-solving skills.

PAY: $20 – $24.33

As an Equal opportunity employer, DBA Choice Medical Group is committed to a diverse workforce. Employment decisions regarding recruitment and selection will be made without discrimination based on race, color, religion, national origin gender, age sexual orientation, physical or mental disability, genetic information or characteristic, gender identity, and expression, veteran status, or other non-job related characteristics or other prohibited grounds specified in applicable federal, state and local laws. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veterans’ Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact this post for assistance.

For more information about equal employment opportunity protections, please view the ‘EEO is the Law’ poster.

NOTICE: EMPLOYEE POLYGRAPH PROTECTION ACT

YOUR RIGHTS UNDER THE FAMILY AND MEDICAL LEAVE ACT

PAY TRANSPARENCY NONDISCRIMINATION PROVISION

Our environment respects individual differences and recognizes each employee as an integral member of our company. Our workforce reflects these values and celebrates the individuals who make up our growing team.

Choice Medical Group provides a work environment free of harassment and prohibited conduct. We promote and support individual differences and diversity of thoughts and opinion.

Job Type: Full-time

Pay: $20.00 - $24.33 per hour

Schedule:

• 8 hour shift