Claims Examiner I (Remote/Hybrid Option)

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

Job Title:

Cost Center:

Scheduled Weekly Hours:

Employee Type:

Work Shift:

Job Description:

JOB SUMMARY

The Claims Examiner I is responsible for examining claims for accurate processing and providing high quality customer service to providers working with Security Health Plan (SHP) or Security Administrative Services (SAS). The individual applies appropriate processing guidelines to the benefit plans and follows established departmental, organizational and external policies and procedures to process claims and resolve claim issues, escalating the claim when applicable.

JOB QUALIFICATIONS

EDUCATION

Minimum Required: High school diploma or equivalent. Successful completion of the following courses per departmental procedures, within one year of hire: current procedural terminology (CPT), current international classification of diseases (ICD) health care procedure coding system (HCPCS), and medical terminology.

Preferred/Optional: Successful completion of the following post-secondary courses at time of hire: current procedural terminology (CPT), current international classification of diseases (ICD) health care procedure coding system (HCPCS), and medical terminology.

EXPERIENCE

Minimum Required: One year experience in the medical or insurance industry. In lieu of one year experience in the medical industry will accept two years’ of Customer Service experience to qualify.

Preferred/Optional: None

CERTIFICATIONS/LICENSES

Minimum Required: None

Preferred/Optional: None

Given employment and/or payroll requirements of individual states, Marshfield Clinic Health System supports remote work in the following states:

Alabama
Kentucky
Oklahoma

Alaska
Michigan
South Carolina

Arkansas
Minnesota
South Dakota

Florida
Mississippi
Tennessee

Georgia
Missouri
Texas

Idaho
Nebraska
Utah

Illinois
North Carolina
West Virginia

Indiana
North Dakota
Wisconsin

Iowa
Ohio
Wyoming

Kansas

States not listed above are not approved for out of state remote work.

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first.

At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every individual should have the opportunity to attain their highest level of health. We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. .

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.