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Graham Personnel Serviceshttps://cdn.haleymarketing.com/templates/62762/logos/graham-personnel-services-social.pnghttp://www.grahamjobs.comhttp://www.grahamjobs.comUSD4992052000YEARtrue
Posted: 07/29/20242024-07-292024-09-11Employment Type:PermanentJob Number: ET114545729Pay Rate: $49920-52000 / year
Job Description
Graham Personnel Services has an immediate opening for a Medical Claims Examiner for a local Health Benefits provider in the Triad. REMOTE opportunityMUST have a minimum of 2 years of related claims experience This position reports to the Medical Claims Manager and is responsible for each respective client's medical claims adjudication and handling of appeals. This is a work from home position that will require a dedicated work space with minimal distractions. Essential Functions • Must read and interpret language in respective client’s Plan Document to ensure accuracy in processing claims.• Must read and verify accuracy of any plan amendments, restatement of benefits, or new group documents• Gather any additional information needed in the processing of any claims• Responsible for all assigned clients and their members in the area of claims adjudication.• Rely on Claims Processing Manual, Trilogy and written Procedures to determine accuracy of coverage for services billed• Attach and process correspondence that needs to be linked to appropriate claims and member history• Answer emails within 24 hours responding to members/providers/clients, etc.• Scan and email appeals• Perform adjustments and request refunds as necessary• Post refund checks while adjusting the claim based on the situation• Contact doctors, hospitals and claimants when investigation of claims is necessary• Investigate and bring to conclusion any questionable charges through written or verbal communications• Maintain a minimum of 98% overall (financial and non-financial) quality accuracy on claims• Review and correct any errors found in the claims audit process• Determine any correlation in the Coordination of Benefits (COB) on each claim, verify information and coordinate calculation of benefits before issuing payments• Maintain no more than a three-day turnaround on all claims for assigned groups (or turnaround time as determined by Manager)• Keep open communications with Medical Claims Manager on any unusual claims• Review and investigate appeals. Forward appeals and related documentation to manager or designated person for review.• Perform any other duties as delegated by the Medical Claims Manager• Answer member/provider calls for particular groups that are not set to use general customer service Knowledge, Skills and Abilities • Must possess proficiency in Microsoft products, particularly Excel and Word. • Excellent verbal and written communication skills required. • Must have the ability to calculate and perform adjustments with strong basis in math. • Ability to utilize the available time to organize and complete work within given deadlines. • Ability to work independently with minimal supervision. • Ability to take care of the customers’ needs while following company procedures. • Ability to pay attention to the minute details of a project or task. • Ability to get along well with a variety of personalities and individuals.
Minimum Qualifications
High School Graduate or General Education Degree (GED)
