What are the responsibilities and job description for the Claims Examiner position at VirtualVocations?
A company is looking for a Claim Examiner to determine the proper payment of medical claims based on clients' customized plans.Key ResponsibilitiesReview and analyze health care claims for cost reasonableness, medical necessity, and fraudDetermine benefit eligibility and payment levels for submitted claimsDocument and process claims in the QicLink System, ensuring compliance with privacy lawsRequired QualificationsHigh School Diploma; College and Advanced Degrees preferredMinimum of 5 years of medical claims analysis experience, including dental and vision claimsStrong analytical skills and knowledge of CPT and ICD-9 coding terminologyContinuing education in areas affecting group health and welfare plans is requiredAbility to work with computer-based programs for extended periods
