Claims Examiner
Job Description: The Claims Examiner I is responsible for inbound calls from providers and health plans and adjudicates physician claims, in a timely and accurate manner. We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, and Washington. Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings Job Details: Provides superior customer service consistent with company standards and goals, including inbound calls from providers and health plans. Responsible for quality and continuous improvement within the job scope. Also responsible for all actions/responsibilities described in company-controlled documentation for this position. Contributes to and supports the corporation’s quality improvement efforts. Processes medical claims (CPT, ICD, and Revenue Coding) at production standards, including timely follow-up on inquiries received and correctly logs all incoming calls and emails. Maintains the minimum accuracy standard and follows up timely to meet compliance standards for claims, pends, and tasks. Reviews claim images and batches to ensure accuracy. Uses proper plan documentation to determine benefits and correctly adjudicate. Meets and maintains the minimum production in addition to completing reports and projects given by the supervisor. Effectively participates in meetings, training, and committees as designated by the supervisor. Reviews feedback from supervisors, trainers, auditors, examiners, and trending spreadsheets. Identifies and implements required steps for improvement.
Minimum Qualifications
One year of claims processing, claims logging, or customer service experience in a managed care environment. - and - Demonstrated minimum of 100 SPM on ten key and 30 WPM typing.
Preferred Qualifications
Associates degree or some college level coursework. Degree obtained from accredited institution. Education is verified. - and – Demonstrated excellent verbal, written, and interpersonal skills. - and - Demonstrated consistent accuracy and processing efficiency in work. - and - Demonstrated ability to resolve complex claims problems and be detailed oriented. Manual dexterity, hearing, seeing, speaking. Location: Nevada Central Office Work City: Las Vegas Work State: Nevada Scheduled Weekly Hours: 40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $18.93 - $27.45 We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice.