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Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates.
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As a Claim Examiner, you will handle processing and adjudication for healthcare claims. Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
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Brighton Health Plan Solutions (BHPS) is seeking an experienced Healthcare Claims Examiner skilled in the interpretation of Hospital and Ancillary contracts, Medical Policies and Payment procedures as well as capable of manually processing claims according to all outlined Policies and Procedures.
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2 years experience processing long term disability claims. Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.
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A claims examiner must have the ability to interpret and apply laws, rules and regulations as well as evaluate claims from initial report to final determination. Health insurance claims processing experience and insurance regulation knowledge highly preferred.
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A Senior Associate is responsible for analyzing, processing, researching, adjusting and adjudicating claims which will result in a payment or nonpayment of a claim with minimal guidance from the medical team or leadership team.
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5 years' experience processing long term disability claims. The Stable and Mature LTD Claim Examiner will manage an assigned caseload of Long Term Disability cases. Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact.
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The Claim Examiner II obtains and analyzes information to make claim decisions and payments on Long Term Disability "LTD" and Waiver of Premium "WOP" claims. Fully investigates and adjudicates a large volume simple to complex claims.
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Minimum of one-year experience working closely with health claims or in a claims processing/adjudication environment; required. · Understanding of health claims processing/adjudication.
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To learn more about the Claim Examiner II position, watch our exclusive employee video! Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner.
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Must have a thorough understanding of insurance-related legal procedures, regulations, and claims processing. Evaluate claims and rectify policy coverage issues in excess of Examiner authority.
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Assisting Claims Examiner III as needed for special requests. At least 1 year of healthcare claims processing experience in a managed care environment. Previous Medi-Cal or Medicare claims processing experience.
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The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.
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3+ years' experience with Florida insurance laws and Florida good faith claims handling required. Ensure superior customer service is delivered with each insured, as well as external business partners, throughout the process of handling and/or disposition of claims.
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The Claims Examiner II will administer all claims adjudication processing professional and facility medical, dental and vision claims in accordance with regulatory guidelines and contractual agreements based on VIVA HEALTH guidelines.
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