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Position Title: Claims Examiner 4
Position Requirements: Full-Time Position

The Claims Examiner 4 is responsible for assisting the Director and Manager of Claims, assisting with the auditing functions in the Claims Department and processing Inpatient claims in a highly efficient manner, while meeting or exceeding departmental goals and serving as a resource for other claims examiners.

Essential Functions:

• Review and process inpatient claims in accordance with the plan benefits, authorization requirements, coordination of benefits, subrogation, and state insurance mandates

• Conduct audits of Claim Examiners’ work product to ensure that staff meet or exceed accuracy standards.

• Conduct audits of Vertexers’ work product to ensure that staff meet or exceed accuracy standards.

• Assist with handling of complex claims as determine by Claim Management

• Must have a quality level of 98% or better

• Assist with incoming and outgoing claim department phone calls

• Flexible work schedule needed to handle incoming phone calls

• Required to meet or exceed claim production goals as set by management while meeting or exceeding the department quality goal

• Handle investigation and data input of coordination of benefits and subrogation information

• Other duties as assigned

The ideal candidate must have a High School Diploma. Over five years of previous experience in claims processing. Past experience paying Medicaid and Medicare claims preferred. Knowledge of Managed Care. Solid understanding of the full adjudication process. Knowledge of medical terminology, ICD-9 and CPT-4 codes

Position Reports To: Manager of Claims