What are the responsibilities and job description for the Claims Examiner I position at Choice Medical Group?
Our Claims Examiner will be responsible to run reports daily to process Contracted and Non-Contracted claims timely for Commercial and Senior members. Review PDR/Appeals/Re-Openings received to make determination. Any additional task provided by Supervisor/Manager/Director.
Qualifications:
· Must have a minimum of three years Claims experience in a medical group setting.
· Work independently as part of a team
· Strong organization skills: ability to multitask and properly manage time
· Preferred knowledge of Medicare and Commercial rules and regulations
· Knowledge of using Crystal Reports/Ez-Cap
· Knowledge of processing non-contracted/contracted claims
· Knowledge of processing PDR’s/Appeals
· Must have an understanding on how to read and interpret DOFR and Contracts
· Must understand how to read a CMS-1500 and UB-04 form
Skills:
· Must have effective communication, facilitation, interpersonal and professional diplomacy skills.
· Strong attention to detail with ability to manage multiple priorities while meeting deadlines.
· Able to Problem-solve, negotiate, and demonstrate independent decision-making.
· Strong communication skills in both oral and written form.
· Positive attitude and takes a team approach to management.
· Maintain strong skills in diplomacy, professionalism, and trustworthiness.
· Familiarity with Microsoft applications, which include the ability to learn new computer systems and applications.
· Ability to manage multiple priorities and projects.
· Detail oriented with desire for producing work with 100% accuracy.
· Excellent analytical and problem-solving skills.
Job Type: Full-time
Pay: $20.00 - $25.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Day shift
- Monday to Friday
Work Location: In person
Salary : $20 - $25
