The Claims Examiner will act as a liaison between client, employee and healthcare provider. In this position, you are responsible for applying appropriate claims management by providing reliable and responsive service to claimants and clients.
Description of responsibilities:
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Investigates claim issues providing resolution within departmental and regulatory guidelines.
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Interprets and administers contract provisions: eligibility and duration
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Accurately codes all system fields with correct financial, diagnosis and duration information.
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Coordinates with other departments to ensure appropriate claims transition or facilitate timely return to work.
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Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations.
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Actively contributes to customer service, quality and performance objectives.
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Proactively engages in departmental training to remain current with all claim management practices.
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Responsible for managing Performance Guarantee clients and meet targeted metrics.
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Responsible and accountable for maintaining and protecting personal health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
Qualifications:
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High School Diploma or GED (Bachelor’s preferred)
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Ability to develop proficiency regarding required RSL products, systems and processes related to the effective delivery of new business proposals
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Microsoft Office experience
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Attention to detail, analytical skills, and the ability to collaborate with others and work independently
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Strong organizational skills, including the ability to prioritize work and multi-task
