About the Client: 

Our client is a health care solutions and services company. 

About the Role: 

The Claims Examiner is responsible for the accurate and timely processing of claims per regulatory and contractual guidelines. The Claims Examiner will be responsible for processing claims for all healthcare lines of businesses (direct contracts, PPOs…) reviewing complex claims, Coordination of benefits, medical coding, and authorization payment allocation for expatriate programs and travelers.

Responsibilities: 

• Responsible for accurate and timely filing adjudication of claims according to state and federal regulations
• Analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes, under the correct provider and member benefits
• Process both professional (CMS 1500) and institutional (UB-04) claim types
• Reconciliation of historical paid data and provider A/R
• Maintain quality and productivity standards as set by management
• Knowledge of HIPAA Privacy Rules
• Resolve provider network claims inquiries and apply resolution in a timely fashion
• Audits claim entry process for quality assurance
• Must have experience in processing Medicare/Medicaid/Commercial products
• Exceptional Customer Service and organizational skills
• Required to uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required

• Bachelor's Degree or equivalent preferred
• Healthcare claims experience preferred.
• Customer Service Contact Center experience
• Knowledge of Microsoft Word, Excel and Outlook.
• 1-2 years’ experience processing Medicare and Medicaid claims.
• Exceptional Customer Service and organizational skills
• Extensive knowledge of medical terminology with thorough comprehension in the usage of Revenue, and ICD-9, CPT, and ICD codes.

Interested? Apply directly now or call (954) 549-1071 for more information. Questions? Email [email protected] for more information on this role and others. 

*CAREERXCHANGE® is an equal opportunity employer. We will present the most qualified candidates to our clients based on the skills required to perform the job. For additional opportunities please visit www.careerxchange.com