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in Folsom, CA

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Hours Full-time, Part-time
Location Folsom, CA
Folsom, California

About this job

The Claims Examiner is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Processes claims by performing the following duties.

Essential Duties and Responsibilities include the following.

  • Compares data on claim application with policy file and other company records to ascertain completeness and validity of claim.
  • Ensures all claims are coded properly.
  • Maintains high quality standards to avoid paying claim incorrectly.
  • Maintains productivity standards set by Lead or manager.
  • Contacts doctors, lawyers, or others involved to resolve claim/coverage questions.
  • Examines claim adjustors' reports or similar claims/precedents to determine extent of coverage and liability.
  • Corresponds with agents and claimants to correct errors or omissions on claim forms, and to investigate questionable entries.
  • Refers most questionable claims to investigator or to claim adjuster for investigation and settlement.
  • Researches paid and denied claims received from Customer Support and reply as needed.
  • Performs other duties and responsibilities as assigned by Management.

 

Knowledge, Skills, & Abilities:

  • Excellent written and verbal communication skills.
  • Strong analytical skills and problem solving skills.
  • Must be dependable and maintain excellent attendance and punctuality
  • Subject-matter expert within field.
  • Must be able to perform data entry operations quickly and accurately.
  • Ability to grow with changing demands of the position and the company.
  • Strong computer skills, including Word, Excel, and Outlook.
  • Must be highly proficient in ICD-9, CPT, and HCPCS codes.

Education and/or Experience:

Associate's degree (A. A.) or equivalent from two-year college or technical school; or one year related experience and/or training; or equivalent combination of education and experience.