Claims Examiner

Position's General Duties and Tasks

• Process claims by following the policies and procedures as defined by the customer.
• Take up additional trainings/ new assignments or projects that may come up as per client needs.
• Meet/ exceed required performance measures such as quality and productivity standards
• Meet/ exceed process SLAs
• Confirm to the required regulatory and compliance requirements such as the HIPAA.
• Confirm to the organizational and client training requirements
• Understand how work impacts results for their area as well as other processes.
• Demonstrate knowledge of internal operations and develops relationships to facilitate workflow.
• Knowledge of related regulations and standards.
Strong understanding of current processes and procedures and may identify opportunities for improvement.

Requirements for this role include:

• High school Diploma or equivalent.

• 3 years of claims processing experience in a Health care payer/ BPO/ TPA setting (Claims Examiners)
• 3 years of Medicaid claims processing experience using Amisys
• 3 years of processing COB and Dual claims
• 5 years of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, leverage internet search engines, and other web based applications.
• 5 years of experience with the Microsoft Office suite that required daily usage of Outlook, Excel and Word.
• Ability to type 40 WPM

Required schedule availability for this position is Monday-Friday (08:00am to 08:00pm CST/EST) . The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.

Position's General Duties and Tasks:

Process claims by following the policies and procedures as defined by customer. Take up new assignments or projects that may come up as per clients needs. Meet/exceed required performance measures such as quality and productivity standards. Meet/Exceed process SLA's. Understand how work impacts results for their area as well as other processes. Demonstrate knowledge of internal operations. Knowledge of related regulations and standards.

Position's General Duties and Tasks: Process claims by following the policies and procedures as defined by customer. Take up new assignments or projects that may come up as per clients needs. Meet/exceed required performance measures such as quality and productivity standards. Meet/Exceed process SLA's. Understand how work impacts results for their area as well as other processes. Demonstrate knowledge of internal operations. Knowledge of related regulations and standards.