What are the responsibilities and job description for the Claims Examiner position at INDEPENDENT LIVING SYSTEMS?
Job Details
Description
POSITION SUMMARY
The claim examiner is responsible for timely and accurate data entry and adjudication of medical and hospital claims.
REQUIREMENTS FOR ALL POSITIONS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl.
The employee must occasionally lift and/or move up to 25 pounds, and infrequently up to 50 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision, and the ability to adjust focus.
The noise level in the work environment is usually moderate.
POSITION RESPONSIBILITIES AND ACCOUNTABILITY
- Examine, data enter, calculate and adjudicate insurance claims complying with federal, state and county laws, plan policy and company procedures
- Enter codes and verify data for computer processing
- Maintain individual production count
- Update and maintain policy manual timely
- Assist in provider services call center as needed.
- Complete miscellaneous assignments upon request
- Maintain production and quality scores as follows:
Expectations |
|
QUALITY STANDARD |
|
99%-100%: |
World Class |
95%-98% |
Needs Improvement; Not passing |
Below 95% |
Unacceptable |
|
|
|
CLAIM EXAMINER STANDARD PER HOUR |
|
0-3 Months |
10 |
3-6 Months |
12 |
Over 6 Months |
14 |
POSITION QUALIFICATION
- High School Diploma/GED required; college course work preferred.
- Experience processing UB04 and CMS 1500 claims
- Self-starter, conscientious, independent worker.
- Strong knowledge of Customer Service skills and techniques required.
- Excellent written, verbal and grammatical communication skills required.
- Ability to read, interpret, analyze technical / business procedures and / or governmental regulations required.
- Ability to write reports, business correspondence and procedural manuals required.
- Knowledge of automated systems (technical adeptness) required.
- Demonstrated proficiency in Microsoft programs (ie, Excel, Word, PowerPoint) required; knowledge of Microsoft Access preferred.
Qualifications
