Claims Examiner II
Responsible for adjudicating more complex entering claim types for claim payments, allowable amounts, limitations, and exclusions and denial of claims. Responsible for meeting all production, quality, and attendance guidelines as outlined by the claims department.
- High School Diploma or equivalency.
- Two years related data entry OR combination of the on the job work experience and medical related education to meet the minimum two years required.
- One year of claims experience on Amisys required or two years of claim processing experience.
- Self-motivated and able to work with minimal direction.
- Ability to read and understand claims processing manuals, medical terminology CPT codes, and perform basic processing procedures. Ability to read and understand health benefit booklets.
- Proficiency in the use of personal computers including claims processing software.
- Successful completion of Health Care Sanctions background check.
- Effective oral and written communication skills.
- Must have high attention to detail.
- Ability to perform basic mathematical calculations.
- Ability to maintain quality and production standards.
- Ability to converse and write fluently in English.