Claims Examiner Job in New York 10007, New York Us
JOB SUMMARY:
Job Title: Claims Examiner
Department: Claims
Reports To: Claims Manager
Position Summary:
The Claims Examiner will be responsible for processing medical, facility, pharmacy, dental and vision claims accurately and efficiently through on-line claims processing system for Third Party Administration.
Essential Duties and Responsibilities:
• Review, investigate and adjudicate claims and encounters for medical, facility, pharmacy, dental and vision services that involve the application of contractual provisions in accordance with provider contracts and authorizations.
• Process claim suspensions from the system to correct processing discrepancies and other edits by reviewing online information while applying Healthfirst policies and procedures
• Ability to absorb, retain and apply a wide range of information about the company, the policies and procedures and benefits.
• Must be able to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Meet individual and departmental standards with regards to quality and productivity.
Education Requirements:
High School Diploma or GED
Other Requirements (License, Certificate, Other):
ICD-9/Coding
Work Experience:
3-5 years
Technical Skills:
Basic Microsoft Word and Microsoft Excel. Intermediate PC Knowledge and Microsoft Outlook
Physical Demands:
While performing the duties of this job, the employee is frequently required to sit key.
Work Environment:
While performing the duties of this job, the employee regularly works in an indoor environment.
Additional Information:
4 years of related claims processing experience-preferably working in a TPA or HMO or managed care environment. TPA tasks and services such as premium billing, COBRA administration, flexible spending and disability processing a plus. This position provides opportunity for Home Based Working to employees who consistently meet and exceed quality and productivity measurements.
Conditions of Employment: Employee must pass pre-employment screening which includes a background check and drug testing. Employee must present documentation to verify minimum of high school educational requirement.
Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability or veteran status.
Requirements:
PLEASE APPLY ONLINE
https://www9.ultirecruit.com/HFM1000/jobboard/NewCandidateExt.aspx?__JobID=4237
For consideration apply online at www.healthfirstny.org
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