Ajilon is working with a healthcare company hiring a Medical Claims Examiner paying $17.00-$19.00 per hour depending on experience. If you have previous medical claims experience, apply today!
Processing of professional and facility medical services claims by reviewing and inputting data into the claims payment system using standard policies, procedures and guidelines.
Must meet quality/accuracy standard of 95% and production standards of 100-125 claims/day.
Forward claims to appropriate departments for Med Review, Eligibility, etc.
Verification of coverage and contract interpretation.
Pursues and follows up on open and pended claims promptly and independently.
Researches and investigates claims with multiple coverage and complexity to determine if claim is payable in accordance with various policy provisions. If payable, determine eligible payee(s) and payment amounts. If not payable, develop detailed letter of explanation based on policy provisions and claim documents.
Critical thinker who can maintain focus and stay on task with minimal supervision
Participates and practices principles of continuous quality improvement
2+ years of Medical Claims processing/examining experience.
Must be comfortable with MANUAL claims process
High school diploma or equivalent
Proficient in Microsoft Office Suite
If you meet the above requirements, apply today! For quicker consideration, please send a copy of your resume to firstname.lastname@example.org
Equal Opportunity Employer/Veterans/Disabled
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The Company will consider qualified applicants with arrest and conviction records
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