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NaphCare, Inc. has an excellent opportunity for a Sr. Claims Adjudicator (Claims Examiner Tier II, Claims Analyst Tier II) to join our team at the Corporate Headquarters in Birmingham, Alabama.
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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 U.S. Back Office Customer Service (BOCS) organization is seeking a Claims Examiner in our Annuity Team of Beneficiary Fulfillment. Key Responsibilities:Creating a fast, accurate, and seamless experience for the beneficiaryCommunicating to our beneficiaries and advisors in a professional manner, both verbal and written to bring claims into good orderDetermining good order of requirements and processing the claimApply procedures and interpret contractual provisions.
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Calculate of benefitsParticipate in projects as neededQualifications:Mandatory overtime required, sometimes on short notice, due to same day processing. The successful candidate will be accountable for the experience of the beneficiary as they key critical death claims transactions and help to move claims into good order by verbal and written communication with our beneficiaries and advisors.
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The Senior Claims Examiner will work on special projects related to provider and plan documents, system upgrades, implementing initiatives to improve claims processing, and turnaround times.
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Advance level (minimum 5 years) of claims processing experience and understanding of medical, dental, FSA, HRA, transplant, coordination of benefits, Medicare, hospital, professional, subrogation, and accident claims required.
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Working knowledge of Employee Retirement Income Security Act of 1974, (ERISA) claims processing/ adjudication guidelines. TheSenior Claims Examiner will process large dollar/complex health care claims, adjustments and contracts that require higher degree of accuracy.
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The Claims Examiner II is responsible for the adjudication of healthcare claims utilizing specific policies and procedures. The Claims Examiner II is accountable for reviewing the adjudication system edits to determine whether to pay the claim and/or line item(s.
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High school education or equivalent and five (5) to seven (7) years of experience as a health claims examiner or comparable industry experience. Resolve benefit and eligibility issues that require detailed knowledge, support customers within the claims processing Company and ERISA guidelines.
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The Claims Examiner works both independently and in conjunction the Claims Team Manager to adjudicate claims, respond to provider or client inquiries in an accurate, timely and professional manner.
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This Senior Claims Examiner is responsible for reviewing, processing, investigating, evaluating, negotiating and the settling of assigned property damage or bodily injury claims with the authority level generally up to $100,000.00.
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Summary: The Medical Claims Examiner I - Processor I is responsible for ensuring claims are coded and processed correctly and for meeting production requirements. Successful candidates must have experience processing medical claims for an insurance company or third party administrator.
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Process claims based on contractual agreements, health plan division of financial responsibility, applicable regulatory legislature, claims processing guidelines and client groups’ and company policies and procedures.
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Claims Processing & Quality Assurance. Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), FSA, foreign claims, outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, and Medicare Secondary Payer (MSP) by calculating benefit due to approve or deny, based on SPD.
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We offer a suite of services including 1:1 Career advice, on demand resources and networking to propel your career forward. We equip and empower our employees to expand their skills and experience by using powerful learning, gigs, and job opportunities.
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