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| Department: | (3367) Claims | ||
| Schedule: | Full-time | ||
| Shift: | Day shift | ||
| Hours: | 80 hrs/pp, M-F, 8am-5pm | ||
| Job Details: |
- High school diploma or equivalent is required
- Experience is required Job Summary: Examine and process paper claims and/or electronic claims. Determines whether to return, pend, deny or pay claims within established policies and procedures. Determines steps necessary for adjudication. Follows established departmental policies and procedures, operating memos and corporate policies to resolve claim and claim issues. Settles claims with Claimants in accordance with policy provisions. Compares claims application and/or provider statement with policy file and other records to evaluate completeness and validity of claim. Pays claimant’s amount due. Job Requirements: High school diploma or equivalent. One to two years claims processing experience. Ability to type 25 wpm, operate 10-key adding machine. Knowledge of CPT and ICD-9, medical terminology, COB processing, subrogation and workers compensation processes (Medicare).
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