Job Ref: TE0175
Category: Claims
Department: CLAIMS
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $50,000.00 - $54,194.00
Position Overview
The Claims Examiner I is responsible for the data entry and system adjudication of provider claims. The incumbent authorizes final disposition of claims within prescribed guidelines in an accurate and timely manner.
Scope of Role & Responsibilities:
Process claims involving medical and/or surgical services; screens for complete member/provider information
Apply administrative policies when necessary, utilizing the claims processing manuals
Authorizes the generation of letters/questionnaires to providers to obtain additional information
Reviews descriptions of services on claims to determine validity of charges of the presence of errors
Evaluates and examines claims pended by the system due to contractual and/or payment discrepancies
Maintains production and quality goals established for the department
Performs other related duties, i.e., maintaining individual production counts, updating manuals and reference materials, attending all refresher training seminars
Required Education, Training & Professional Experience
Associate’s Degree required; and
Minimum 2 years’ experience in the healthcare insurance industry with knowledge of integrated claims processing; or
A satisfactory equivalent combination of education, training, and experience
Proficiency with data entry skills
Through knowledge of medical terminology, CPT, ICD-p, and Revenue Codes
Professional Competencies
Integrity and Trust
Customer Focus
Functional/Technical skills
Written/Oral Communication
#LI-Hybrid
#MHP50
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