Who are we?
A strategic and trusted insurance partner, who help our clients reclaim their precious time through our specialized solutions that alleviate the challenges of acquiring authorizations, managing medical coding, rectifying claims complications, and overcoming denials.
We are a values-based organization where respect, integrity, excellence, collaboration, and passion define who we are and how we do business. We value diversity of backgrounds, experience, and perspectives and strive to foster an inclusive environment that enables all our team members to bring their best selves to work. We are one team committed to building a culture where every teammate has the opportunity to contribute and be recognized.
Job Opportunity:
The position requires the ability to work in a high volume claims environment including daily processing of various types of claims. The Claims Examiner II is responsible for reviewing correcting and releasing claims in the appropriate claim system for payment. The Claims Examiner II will review and release an average of at least 250 claims every day. Claims Examiner II accuracy will be no less than 98%, with a claim goal completion minimum of 95%.
Essential Functions
- Processing of various types of claims.
- Processing of Priority Claims and Member Pays Claim.
- Handling of claim edit issues.
- Back-up for the Claims Examiner I when needed.
Education & Experience
- High School Diploma or equivalent required. AA in business or equivalent preferred.
- Three plus years claims processing (medical, dental and/or vision) is required.
- Knowledge of provider reimbursements and experience in the vision insurance industry would be preferred.
HIPAA & Security Requirements
All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company’s Privacy & Security Training Program