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Form of workJob Description
Position: Medical Claims Examiner Processor
Company: Benefit & Risk Management Services
Location: 80 Iron Point Circle, Suite 200, Folsom, CA 95630- This is an on-site position- Folsom CA
Pay rate $20.00 - $26.00 DOE
Schedule: 8:30am-5pm; Monday thru Friday
Number of openings: 8
Summary: The Claims Examiner I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Processes claims by performing the following duties
Essential Duties and Responsibilities include the following. Other duties may be assigned.
• Compares data on claim with internal policy and other company records to ascertain completeness and validity of claim.
• Comprehensive understanding of employee benefits for medical, dental and vision plans.
• Adjudicates Medical Claims, applies coordination of benefits as outlined in plan guidelines and works with providers to gather the necessary documents to make final payment determination on claims
• Ensures all claims are coded properly.
• Examines Summary Plan Document, claim adjustors' reports or similar claims/precedents to determine extent of coverage and liability.
• Maintains high quality standards to avoid paying claim incorrectly.
• Maintains productivity standards set by Management.
• Refers most questionable claims for investigation to claim examiner II for review and processing.
• Research and resolve paid and denied claims escalations from internal sources and/or TIPS ticketing system when assigned.
• Works from the claims queue manager to process & releases claims for adjudication and payment within 3-5 days of receipt.
• Performs other duties and responsibilities as assigned by Management.
Knowledge, Skills, & Abilities:
• Excellent written and verbal communication skills.
• Strong analytical skills and problem-solving skills.
• Must be dependable and maintain excellent attendance and punctuality
• Must be able to perform data entry operations quickly and accurately.
• Ability to grow with changing demands of the position and the company.
• Strong computer skills, including Word, Excel, and Outlook.
• Successful candidates must have experience processing Medical Claims for an insurance company or third party administrator
• Must be highly proficient in ICD-10, CPT, and HCPCS codes
Education and/or Experience: Associate's degree (A. A.) or equivalent from two-year college or technical school; Must have 3-5 years employee benefits industry experience or equivalent combination of education and experience.
Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, meeting notes, project documentation, and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position.
Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized or non-standardized situations
Benefits:
Medical, Dental, Vision- eligibility is 30 days from start date. ****We pay for the employee’s benefits, if they have dependents, they will have to pay for dependents****
401k-BRMS matches 100% up to 3%, eligibility is 30 days from start date
10 paid Holidays
PTO= they accrue 120 hours the first year
Sick time: 40 hours after they have worked 90 days
If you are interested, please reach out to Arely !626272515O!
