Claims Examiner

Review and finalize claims referred from Data Capture for OPL, Medical review, BGT/coverage, payment level, case management.
On a daily basis work all system generated reports to ensure accurate claims control.
Meet departmental, contractual, and national performance goals.
Maintain required production and accuracy standards.
Be able to finalize claims for Cross, Shield, Major Medical, and Drug lines of business.
By completion of training period be able to adjust claims for Cross, Shield, Major Medical and Drug lines of business for processor related errors
Identify and document system and procedural problems; provide suggestions for resolution.
Must be a team player.
Must comply with corporate compliance program.
Must be able to maintain confidentiality.
Requires constant and intense concentration to complete complex job functions. Work is confining and requires keying at PC up to 80% of the day.

Number of openings:



14.18 per hour

How to Apply:

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