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Claims Examiner I
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- JOB DESCRIPTION SUMMARYThe Claims Examiner I reports to the Supervisor of Claims.
- Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and electronic claims per state, federal, and health plan regulatory requirements and department guidelines, as well as meeting established quality and production performance benchmarks, including research and review of applicable documentation.
- The Claims Examiner I will thoroughly review, analyze, and research health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment.
- QualificationsHigh school education or equivalent: minimum one (1) to three (3) years year of experience as a Health Claims Examiner or comparable industry experience preferred.
- A minimum of one (1)year experience as a Claims Examiner for medical, dental claims and vision, subrogation, and accident claims.
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