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Claims Examiner I

Claims SpecialistClaims SpecialistFull TimeRemoteTeam 10,001+Since 1913H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

1 day ago

Salary

Not specified

High School2 yrs expExperience acceptedEnglish

Job Description

• Under general supervision, assesses claim information, references contracts and performs calculations and other functions to accomplish the processing and payment of insurance claims of a complicated or non-routine nature. • Interprets contract information and communicates with outside parties to obtain information and coordinate coverage. • Performs claim research and adjustments. • Successfully completes all training programs as required for the level. • Processes claims for two products or claim types (dental, hospital, medical, ITS, FEP). • Performs research and adjustment functions for claims. • Perform special projects (e.g., complex accumulator reconsiderations, New Directions). • Responds to written inquiries from internal and external customers as business needs dictate. • Sets up deducts, CLOV table entries, and other assigned finance functions. • For FEP positions, processes all deferrals for FEP or edit corrections in computerized claims system. • Performs complex FEP transactions (e.g., FEP Direct DDE, FEP Retro-enrollment, Out of Balance) and member appeals.

Job Requirements

  • High school diploma or general education degree (GED)
  • 2 years of previous customer service, member services, or claims processing experience; or any combination of required education and experience.
  • Advanced Keyboarding Knowledge
  • Intermediate knowledge of Microsoft Office
  • Knowledge of FACETS and/or other computerized claims processing system as applicable (FEP).
  • Associates degree from college or technical school

Benefits

  • Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
  • Annual incentive bonus plan based on company achievement of goals
  • Time away from work including paid holidays, paid time off and volunteer time off
  • Professional development courses, mentorship opportunities, and tuition reimbursement program
  • Paid parental leave and adoption leave with adoption financial assistance
  • Employee discount program

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