Claims Examiner III

Position Purpose: The Claims Examiner III ensures that claims are processed according to department standards and assists the Claims manager in maintaining the workflow and processes, in order to achieve set goals.

Key Responsibilities:

• Review and release professional and institutional claims
• Process Member Reimbursement claims
• Coordinates with the Assistant Director the weekly/monthly workflow issues and set goals for the department
• Assists the Assistant Director on generating reports to track productivity and pending items
• Collaborate in the application of policies and procedures of the department
• Collaborate with the Assistant Director to ensure the team is meeting production and quality metrics
• Communicate effectible to the department staff the strategy to improve performance and meet stablished goals
• Maintain a positive environment that support staff well-being and foster an atmosphere that builds teamwork
• Ensure that the team utilizes the system capabilities to its maximum potential
• Performs other duties as necessary

Qualifications:

• High School Diploma or GED
• 3+ years as Medical Claims Examiner
• Experience in contract interpretation
• Knowledge of CMS guidelines and regulations
• Ability to work Windows and other computer applications
• Ability to work well with others

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted.