Claims Examiner II

Key Responsibilities: Adjudicate claims submitted by providers and members assigned via claims workflow. Reviewing claims for required information, pending claims when necessary, maintaining a follow-up system, and updating and releasing pending claims when indicated. Correctly match authorizations to ensure claims are processing appropriately based on established guidelines. Work with internal departments to resolve issues preventing claims from processing or enhancing processing capabilities. Meet and maintain performance and quality measurements as required by the department to meet regulatory compliance standards. Required At least 12 years of experience with claims processing 2 years of college or equivalent claims adjudication experience Ability to thrive in a production environment where quality and quantity are highly measured, including recognizing and correcting quality errors Demonstrate excellent customer service skills through written and verbal communication Organized, detail oriented, and skilled at prioritizing and multitasking Ability to work in a team environment, remain flexible to changes, and recognize responsibilities, actively participate with others to accomplish assignments and achieve desired goals Knowledge of medical terminology, ICD, CPT, and HPCSBasic computer skills including Microsoft Word, Excel, and Outlook Understanding of Claims Payment System in order to process claims, prepare reports and correspondence PreferredProfessional and/or hospital claims adjudication experience, preferably in the healthcare/medical fieldCRT data entry experience Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.