What are the responsibilities and job description for the Claims Examiner position at CHRISTIAN BROTHERS SERVICES?
Job Details
Job Location: ROMEOVILLE, IL
Salary Range: Undisclosed
Description
Join us at Christian Brothers Services, where our mission is to support and serve the Catholic Church and its ministries across the nation. We're seeking an analytical and detail oriented professional to join our team as a Claims Examiner. This position is responsible for the timely and accurate adjudication of claims in accordance with established procedures and provisions of the benefit plans. If you are passionate about making a meaningful impact while leveraging your knowledge and skills, we invite you to be part of our dedicated team. Come be a catalyst for positive change with us at Christian Brothers Services!
Position Responsibilities:
- Examine medical/dental/vision claims with responsibility for efficient, accurate evaluation of data and initiation of benefit payment.
- Follow up/follow through on pended claims by evaluating all new and existing supporting documentation for determination of benefits within one week of receipt.
- Collaborate with the Customer Care department to resolve phone inquiries about claims within 24 to 48 hours for urgent issues and one week for standard issues.
- Communicate via telephone or email with members, employers, care providers, and service providers regarding status/circumstances for the resolution of claims.
- Exercise good judgment and in a timely manner when determining escalation of a claim to a Claims Team Lead, Supervisor or internal nurse review (HCR).
- Perform other claim department duties related to adjudication as assigned
- Help identify any system of workflow performance issues
- Twice daily monitoring of individual and departmental workload through computerized reports
Benefits:
- 403(b)
- 403(b) matching
- Pension
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Qualifications
- High School diploma
- minimum of two to five years' claim adjudication experience in a PPO environment
Skills:
- Good analytical skills and a working knowledge of medical coding and terminology
- previous Trizetto processing system experience helpful
- Must be familiar with standard concepts, practices, and procedures related to medical billing
- Familiar with MS applications, including Word, Excel, and basic webpage navigation
- Accurate calculator skills and a minimum typing speed of 40 wpm required
- Must be self motivated, dependable, and detail oriented with excellent communications and problem solving skills
