Claims Examiner

Position Summary

The Claims Examiner is primarily responsible for processing medical claims accurately, and efficiently. The Claims Examiner will work independently with little supervision. This position may assist with special projects and claims reprocessing.

Essential Functions and Responsibilities

• Process claims that require more than basic claims training.
• Calculate other insurance and re-pricing benefits.
• Identify claims issues and escalate these to the appropriate staff for resolution.

Preferred Functions and Responsibilities

• Cross train and work in all processes as needed.
• Process complex medical claims.

Required Skills & Abilities

• High School Diploma/GED or equivalent.
• 1-3 years of experience in claims processing.
• Ability to recognize claims by determining claim type – professional, institutional, and other types.
• Proficient in Microsoft Office suite with 10 key entry; minimum typing speed of 45 wpm.
• Ability to remain focused and productive in a work environment that includes repetitive tasks.
• Basic mathematic skills.
• Good verbal and written communication skills.
• Ability to work independently.
• Ability to be adaptable and offer creativity in a continually changing environment.

Preferred Skills & Abilities

• Experience in medical claims processing.
• Knowledge of medical coding or medical terminology.

Physical Demands

N (Not Applicable): Activity is not applicable to this position.
O (Occasionally): Position requires this activity up to 33% of the time (0 – 2.5+ hrs/day)
F (Frequently): Position requires this activity from 33% – 66% of the time (2.5 – 5.5+ hrs/day)
C (Constantly): Position requires this activity more than 66% of the time (5.5+ hrs/day)

Lift/Carry

Push/Pull

Work Environment

General office environment.