Claims Examiner – Lead
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Job Description
Claims Examiner Lead overseeing Claims Examiner team operations and training. Ensuring competency, measuring performance, and providing excellent service in claims processing.
Responsibilities:
- Manage daily operations of the Claims Examiner team
- Assist with work distribution and individual performance tracking
- Measure competency and production levels
- Respond to technical questions from claims examiners
- Assist the supervisor in implementing new processes and procedures
- Perform auditing tasks
- Provide training to internal users on plan benefit matrix and claims policies/procedures
- Process claims and serve as a role model for staff
- Evaluate complex medical, dental, and behavioral health claims
- Provide excellent customer service to internal and external customers
- Document all activities using CareOregon's on-line phone tracking system
- Meet or exceed Department and Company policies including quality and production
- Identify trends and communicate findings and process improvement ideas to the supervisor
Requirements:
- Minimum 3 years’ experience as a medical claims processor in the health insurance industry
- Experience with people and/or project leadership
- In-depth knowledge of claims adjudication principles and procedures
- Advanced knowledge of CPT, HCPCS, Revenue, DPT and ICD-9 coding
- Strong knowledge of medical, dental, mental health and health insurance terminology
- Strong understanding of federal and state laws and other regulatory agency requirements that relate to the medical, dental, mental health and health insurance industry or Medicaid/Medicare industry
Benefits:
- Health insurance
- 401(k) matching
- Flexible spending account(s)
- Employee assistance program
- Wellness program
- Discounts
- Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings)
- Strong retirement plan with employer contributions
- Paid time off and Sick time
- Paid holidays
- Volunteer time
- Jury duty
- Bereavement leave
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