Medical Claims Examiner

Medical Claims Examiner

Qualifications

· Experience:

· Claims Processing, 1 year (Required)

· Location:

· Greenville, SC (Required)

Full Job Description

BSI Companies is seeking a highly energetic, self-motivated candidate with previous experience in a TPA or medical insurance background. This candidate must be detailed-oriented. The Claims Examiner is responsible for processing medical, dental, vision and Flexible Spending claims in accordance with CMS and the member plan benefits.

RESPONSIBILITIES:

Performs through review of pended claims for billing errors and/or questionable billing practices that might include duplicate billing and unbundling of services.

· Corrects system generated errors manually prior to final claims adjudication.

· Process claims based upon the provider’s contract/agreements or pricing agreements, applicable regulatory legislation, claims processing guidelines and BSI policies and procedures.

· Alerts manager or supervisor of more complex issues that arise.

· Processes claim exception reports as assigned

· Maintain required levels of production and quality standards as established by management.

· Attendance at employer worksite is an essential job requirement.

QUALIFICATIONS:

· Preferred minimum of one year experience in medical claims processing, third party administration or a self-pay claims processing system.

· Current working knowledge of ICD-10, CPT, ADA, revenue codes and all applicable bill types.

· Proficient with medical coding and terminology.

· Good verbal and written communication skills.

· Ability to work under pressure and adapt to changing environment.

· Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines.

· Proficient in Microsoft Office (Word, Excel, Outlook).

· Reliability and a strong work ethic are a must.

Job Type: Full-time

Schedule:

· 8 hour shift

Experience:

· Claims Processing: 1 year (Required)

Location: Greenville, SC (Required)

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Ability to Commute:

• Greenville, SC 29601 (Required)

Ability to Relocate:

• Greenville, SC 29601: Relocate before starting work (Required)

Work Location: In person

Salary : $18 - $22