Medical Claims Examiner

The Claims Analyst position responsible for processing medical, dental and vision claims.

• Review and process medical claims according to Plan guidelines within established turnaround time frames
• Interpret medical plan to assure system is coded correctly
• Review claims for legitimacy and accuracy
• Meet production and quality standards set for examiners
• Work Customer Service inquiries related to claim questions
• Review correspondence submitted by members and providers and adjust all related claims if the additional documentation submitted warrants adjustment
• Other duties as assigned

• High School/GED required

• Demonstrate skills in problem solving and benefit plan interpretation
• Knowledge of CPT codes, ICD10 codes and/or medical terminology is a plus
• Ability to work independently
• PC proficiency
• Average typing ability