What are the responsibilities and job description for the Claims Examiner position at eTeam?
Job Title: Claims Examiner
Duration: 06 Months High possibility of extension
Location: Houston, TX 77401
Schedule Notes: Start time anytime between 7:00 to 8:30 a.m. and Hybrid (working in office M, W, F- with every other Friday remote)
Job Description:
Responsibility A: Adjudicate Claims received into processing.
Duration: 06 Months High possibility of extension
Location: Houston, TX 77401
Schedule Notes: Start time anytime between 7:00 to 8:30 a.m. and Hybrid (working in office M, W, F- with every other Friday remote)
Job Description:
Responsibility A: Adjudicate Claims received into processing.
- Task #1: Thoroughly reviews, investigates, and adjudicates claims daily, working oldest to newest claims in 30 days or less, and 98% of the time.
- Task #2: The examiner should process a minimum of 14 claims per hour or 98 claims per day.
- Task #3: Review and investigate pending claims and follow up with internal and external departments to finalize claims resolution within 30 days.
- Task 4: Macess requests are processed within 30 days of receipt, with a 98% accuracy, to ensure timely resolution of claims, in adherence with HHSC regulatory requirements.
- Task #1: The claims should be adjudicated with a 98% procedural accuracy rate monthly as reviewed by weekly audit reports.
- Task #2: The claims should be adjudicated with a 98% accuracy rate monthly as reviewed by returned claims for adjustment review.
- Task #3: The claims that are manually adjudicated must have notes entered as reviewed by weekly audits, check run, returned claims, management review 98% of the time.
- Task #4: Clear concise documentation/notes must be entered for each claim reviewed, which provides a historical reference of how the claim was processed at the time of adjudication.
- Required for completely satisfactory performance in this job is a knowledge of ICD-9, CPT/HCPCS coding methodologies (and their successors); claims examination functions
- Adjudicate claims received into the processing system.
- The formal education required for completely satisfactory performance in this job is a high School Diploma or GED and 2 years of claims experience.
