Claims Examiner II

Position Overview

The ideal candidate will have experience processing healthcare claims in a high-volume Claims Department. Must be computer literate and have ability to enter data into computer system with speed and accuracy. Must be able to demonstrate time management and strong organizational skills.

Scope of Role & Responsibilities

• Process all claims identified as exceeding claim age parameters established within the unit (28+ days)
• Process complex, difficult, and non-routine claims for multiple lines of business
• Audit work of assigned claims examiners to ensure accuracy.
• Identify policies of common errors requiring retaining sessions
• Assist with retraining sessions as directed.
• Participate in quality projects as required by management.

Required Education, Training & Professional Experience

• Bachelor’s degree is required; a Master’s degree is preferred, or an equivalent combination of education and relevant experience that demonstrates satisfactory equivalency.
• At least three (3) years’ experience of claims in a managed care or hospital setting is required.
• Strong data entry skills are essential.
• In-depth knowledge of adjustment processing, medical terminology, CPT, ICD‑P, and revenue codes is required.
• Proficiency in Microsoft Office applications, including Word, Excel, and Access, is required.
• Must be capable of performing all duties and responsibilities of Claims Examiners within the department.

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication
• Must be able to communicate adequately both verbal & written
• Must have excellent interpersonal skills

#LI-Hybrid

#MHP50