Claims Examiner 1

Under close supervision, process routine claims within two or more product lines to determine type and amounts of benifit payable. Performlimited duties, subject to review and approval, for prcessing of such claims assigned, consistant with applicable polocies, procedures and department guidlines.
Determines level of reinbursment based on established criteria, provider contract, plan and employer group provisions. Revire all decisions with superior or senior staff. With approval, proceddes all claims eligible or ineligible for payment desisions. Respond by telephone or writing to providers,members,or other company departments to process and resolve the claim issue.
REQUIREMENTS
ICD 9, CPT Coding
Typing 55WPM, 2 years of health claims examiner experience, Medical terminology, must be able to read and interpret benefit contracts and standard reference material skills- ability to self manage in a fast paced, detail oriented environment. Ability to operate PC based software programs or automated database management system preferred. Must perform 10 key by touch. Must have strong communication skills with strong analytical and problem solving skills. Knowledge of managed care industry. standard claim forms and physician billing coding.