About This Role
This role involves reviewing and processing healthcare claims, ensuring they align with contractual agreements and processing guidelines. The Claims Examiner supports the team by handling complex claims and maintaining high standards of quality and production.
Responsibilities
- Comply with all internal processes and procedures to ensure activities are handled in accordance with departmental and company policies and procedures
- Review, research, analyze, and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g., verify pricing, prior authorizations, applicable benefits)
- Escalate claim and/or system issues to Team Lead or Supervisor
- Create and support a professional environment which fosters teamwork, cooperation, respect and diversity
- Meet department quality and production requirements
- Meet and maintain performance goals established for the position in the areas of quality and production
- Process claims for multiple Lines of Business as requested by management
- Understand processing rules for multiple lines of business and support other lines of business as needed to meet business needs
Requirements
- High School/GED required
- 1 to 3 years prior claims experience
- Mathematical aptitude and analytical skills
- Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
- Ability to research and investigate information using multiple sources and documented guidelines
- Strong interpersonal skills
- Excellent listening, verbal and written communications skills
- Excellent comprehension, reasoning and decision making skills
Nice to have:
Benefits
- Flexible work solutions including remote options, hybrid work schedules
- Paid time off including holidays and volunteer events
- Health insurance coverage for you and your dependents on Day 1
- 401(k)
- Tuition reimbursement
Important Details
- Internet connection: Reliable high-speed internet (minimum 50 Mbps download and 5 Mbps upload) required for 100% remote or hybrid roles
About the Company
AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience, dedicated to helping people get care, stay well and build healthy communities. As a leader in healthcare solutions, the company offers integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
