Claims Examiner in Meridian, ID at Volt

Date Posted: 1/30/2020

Job Snapshot

  • Employee Type:
    Contingent
  • Location:
    Meridian, ID
  • Duration:
    12 weeks
  • Date Posted:
    1/30/2020
  • Job ID:
    216218
  • Pay Rate
    $15.0/Hour
  • Contact Name
    Volt Branch
  • Phone
    208-375-9930

Job Description

POSITION PURPOSE:

To assure accurate and timely claims processing within corporate standards for all contracts processed in the Traditional Claims Unit.

MINIMUM POSITION REQUIREMENTS:

Required Experience:

  • Six months claims or customer service related work experience in the health insurance
    industry; or
  • 18 months work experience in a general office or medical office environment

Knowledge of:

  • Medical Terminology

Skills:

  • Microsoft Outlook – Basic
  • Microsoft Word – Basic
  • Microsoft Excel – Basic
  • Typing – 35 wpm
  • Ten-key – 75 kspm
  • Math – Basic
  • Organizational
  • Time Management
  • Verbal & Written Communication
  • Problem Solving

Ability to:

  • Work in a team environment
  • Research and navigate web-based programs
  • Work with detailed-oriented material
  • Work overtime periodically as needed
  • Follow detailed workflow and instructions

PREFERRED QUALIFICATIONS:

  • Knowledge of master contracts
  • Knowledge of provider and ancillary pricing
  • Knowledge of Facets systems
  • Health claims processing (such as Medicare, Medicaid)
  • Knowledge of coding/CPC
  • SharePoint

PRIMARY ACCOUNTABILITIES: 

  1. Consistently ensure timely and accurate acceptance of claims through the review of claim history and edit or deferral reports including the simple manual computation of benefits, both in- and out-of-network, by entering data using available resource materials such as contracts, contract benefit files, etc. Refer questionable and non-routine claims to more experienced personnel.
  2. Access online policies, procedures, manuals, contracts, e-mails received through Outlook,etc., and stay current on all other information related to benefit administration
  3. Recognize and report problems and potential errors in network, fee schedule, or other plan systems.
  4. Analyze the reasons for the edits of the claims data and take appropriate action needed to process claims, including directing claims to Medical Management for medical determinations.
  5. Recognize, investigate, and report immediately any abnormal or aberrant claim practices or system configuration issues to the Supervisor or Senior Claim Examiner for review.
  6. Recognize incorrectly processed claims in the member’s history, watching for cascade errors on all previously processed claims and creating and intake for appropriate personnel.
  7. Develop and employ inventory evaluation skills using good time management.
  8. Record and submit accurate work hours and time exceptions in designated applications or operating systems.
  9. Monitor individual quality and efficiency daily using online tools.

SECONDARY ACCOUNTABILITIES:

  1. Assist in quality review of other employees in the department on daily completed work.
  2. Contact providers and other insurance plans as needed for necessary information to accurately process claims.
  3. Perform all other duties as requested by the Supervisor.