Claims Examiner

Job Title: Claims Examiner - Remote

Pay Rate: $14/hr

Schedule: Monday-Friday 8.00am-4.30pm EST (possible overtime)

Job Type: Full Time

FLSA Status: Non-Exempt/Hourly

Grade:H2

Function/Department:Health Plan and Healthcare Services

Reporting to:Team Lead/Supervisor-Operations

Role Description:A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claimsubmittedby member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information thatrequiredfor claims adjudication. The claimsneedto be completed adhering to required TAT and quality SLA.

KeyResponsibilities

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  Should have Excellent Analytical skills to review claims based on rules and workflows.

  
  

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  Need good comprehension skills toadjudicateclaims as per Policies and Procedures.

  
  

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  Should be a complete team player

  
  

Key Performance Indicators:

* Ensuring that the key Service Level Agreements are met consistently without any exceptions.

*Achieve set Production goals.

* Adherence to departmental and company rules and regulations.

Qualifications

The qualifications listed below are representative of the background, knowledge, skill, and/or abilityrequiredto perform their duties and responsibilities satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

Top of Form

Top ofFormEducation

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  High School diploma or equivalent required

  
  

Competencies& Skills

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  Highly-motivatedand success-driven

  
  

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  Exceptionalverbal and written communicationand interpersonalskills, including negotiation and active-listening skills

  
  

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  Exceptionalanalytical and problem-solving skills

  
  

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  Strong attention to detail with a commitment to accuracy

  
  

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  Ability to adapt to change in a dynamic fast-paced environmentwith fluctuating workloads

  
  

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  Basic mathematical skills

  
  

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  Intermediate typing skills

  
  

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  Basic computer skills

  
  

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  Knowledge ofmedical terminology,ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulationspreferred

  
  

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  Knowledge of insurance policies, regulations, and best practicespreferred

  
  

Additional Qualifications

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  Ability todownload 2-factor authentication application(s) on personal device,in accordance withcompany and/or client requirements

  
  

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  Ability topass the required pre-employment background investigation, including but not limited to, criminal history,work authorizationverificationand drug test

  
  

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position may work onsite or remotely from home.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonableaccommodations may be made to enable individuals with disabilities to perform the essential functions.

Must be able to regularly orfrequentlytalk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device. Must be able to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds.

Firstsourceis an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, genderidentityand sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal,stateor local law.