Claims Web Inquiry Examiner

Job Description

The web inquiry examiner is responsible for the review and adjudication of claims inquiries submitted via the web portal, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the IPAs. Researches, reviews and contacts provider services for problem claims and issues, as needed. Suggests process improvements to management and is a resource of information to all staff.

Duties and Responsibilities

• Accurately review all incoming web inquiry requests for adjudication.
• Meets production standards of 20-100 claims as established by claims management.
• Adjust claims in accordance with departmental policies and procedures and other rules applicable to claims.
• Coordinate resolution of claims issues with other Departments.
• Assist Providers and other Departments in claims research.
• Assist in training claims personnel when issues are identified.
• Promote a spirit of cooperation and understanding among all personnel.
• Attend organizational meetings as required
• Adhere to organizational policies and procedures.
• Performs other tasks as assigned by supervisor/manager
• Adhere to MedPOINT Management’s core value: Accountability, Community, Celebration, Integrity, Innovation & Collaboration
  
  

Minimum Job Requirements

High school graduate. One-year experience as a Claims Examiner on an automated claims adjudication system. Strong organizational and mathematical skills. Ability to get work done efficiently and within timeliness guidelines.

Skill and Abilities

• Experience in a managed care environment preferred.
• ICD-10 and CPT-4 coding knowledge preferred.
• Must be detail oriented and have the ability to work independently