Claims Examiner I - A
Job Description Reviews internal databases, client guidelines, and policy contract language to adjudicate routine home and facility based LTC claims, in accordance with department processes and standards.
Queries service providers to obtain licensure information, proof of loss, and claimant dates of service.
Verifies that provider or care is appropriate base on the claimant's diagnosis and is in accordance with contract language and government regulations regarding healthcare providers.
Communicated with Claims Examiners and management on cases requiring special handling.
Keeps clear and concise documentation of all claim activity within the required databases.
Meets quality and production metrics as established and communicated by the department.
Processes requests from the client or from other departmental areas within LTCG.
Other duties as assigned.
Requirements Associates Degree or equivalent formal training program, or 2 years experience in a medical setting 1- 3 years work experience in a claims processing preferred.
Intermediate level experience with Microsoft Office products.
Recommended Skills Claim Processing Databases Metrics Microsoft Office Contract Management Estimated Salary: $20 to $28 per hour based on qualifications.
Queries service providers to obtain licensure information, proof of loss, and claimant dates of service.
Verifies that provider or care is appropriate base on the claimant's diagnosis and is in accordance with contract language and government regulations regarding healthcare providers.
Communicated with Claims Examiners and management on cases requiring special handling.
Keeps clear and concise documentation of all claim activity within the required databases.
Meets quality and production metrics as established and communicated by the department.
Processes requests from the client or from other departmental areas within LTCG.
Other duties as assigned.
Requirements Associates Degree or equivalent formal training program, or 2 years experience in a medical setting 1- 3 years work experience in a claims processing preferred.
Intermediate level experience with Microsoft Office products.
Recommended Skills Claim Processing Databases Metrics Microsoft Office Contract Management Estimated Salary: $20 to $28 per hour based on qualifications.
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