Claims Examiner |
| Position Information |
Title: | Claims Examiner |
Posted: | 08/16/2023 |
Salary: | |
Description: |
Our Health Benefit Services Division has a full-time opening for a Claims Examiner. This position is responsible for the timely and accurate adjudication of claims in accordance with established procedures and provisions of the benefit plans.
Christian Brothers Services is a not-for-profit comprised of cooperative programs providing administrative and managerial services to Catholic organizations. We offer a competitive benefits package!
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Qualifications: |
Responsibilities:
- Examine medical/dental/vision claims with responsibility for efficient, accurate evaluation of data and initiation of benefit payment.
- Follow up/follow through on pended claims by evaluating all new and existing supporting documentation for determination of benefits within one week of receipt.
- Collaborate with the Customer Care department to resolve phone inquiries about claims within 24 to 48 hours for urgent issues and one week for standard issues.
- Communicate via telephone or email with members, employers, care providers, and service providers regarding status/circumstances for the resolution of claims.
- Exercise good judgment and in a timely manner when determining escalation of a claim to a Claims Team Lead, Supervisor or internal nurse review (HCR).
- Perform other claim department duties related to adjudication as assigned
- Help identify any system of workflow performance issues
- Twice daily monitoring of individual and departmental workload through computerized reports
Qualifications:
- High School diploma
- minimum of two to five years' claim adjudication experience in a PPO environment
Skills:
- Good analytical skills and a working knowledge of medical coding and terminology
- previous Trizetto processing system experience helpful
- Must be familiar with standard concepts, practices, and procedures related to medical billing
- Familiar with MS applications, including Word, Excel, and basic webpage navigation
- Accurate calculator skills and a minimum typing speed of 40 wpm required
- Must be self motivated, dependable, and detail oriented with excellent communications and problem solving skills
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| Contact Information |
Contact: | Human Resources |
Address: | 1205 Windham Parkway
Romeoville, IL 60446 |