- Reviews and adjudicates medical claims based on health policy provisions and established guidelines
- Requests additional information from members and providers as needed
- Initiates and completes claim investigations when indicated including pre-existing conditions, accidents, medical necessity and appropriateness, eligibility and coordination of benefits
- Documents fully claims referred to senior staff for review and determination
- Maintains company production and quality standards
- Participates in training
- Adheres to the policies and procedures of Premier Administrative Solutions
- Maintains strict confidentiality of client, company and personnel information
- Demonstrates a strong commitment to the mission and values of the organization
- Adheres to company attendance standards
- Performs other duties as assigned
- Strong organizational and interpersonal skills
- Excellent written and verbal communication skills
- Detail oriented
- Ability to multi-task and work independently
- Knowledge of medical and dental coding systems
- Knowledge of medical terminology
- Minimum two (2) years of medical claims processing experience
- Must live a reasonable commutable distance from Clearwater, FL.
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· Overview · Health Insurance Medical Claims Examiner · Monday-Friday Schedule with daytime hours · Responsibilities · Summary: · The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines. · Essential Duties and Responsi ...
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Medical Claims Examiner - Clearwater Beach - Premier Administrative Solutions
Description
Health Insurance Medical Claims Examiner
Health Insurance Medical Claims Examiner (Initial Training On Site - 90 days - Remote position after training in FL)
Must live within a reasonable commuting distance of Clearwater, FL
Monday-Friday Schedule with daytime hours
Responsibilities
Summary: The Medical Claims Examiner adjudicates medical claims based on health policy provisions and established guidelines.
Essential Duties and Responsibilities:
Other Responsibilities:
Supervisory Responsibilities: None
Competencies:
Qualifications
Qualifications:
Education and/or Experience:
High school diploma or equivalent is required
Certificates, Licenses, Registrations:
None
Computer Skills:
Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook
Environmental Factors/Physical Demands:
Training is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.
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Medical Claims Examiner
Only for registered members Clearwater, Florida, United States
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Claims Examiner
Only for registered members Tampa
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Claims Examiner
Only for registered members Tampa, FL
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Claims Examiner
Only for registered members Tampa, FL , Tampa, FL, US
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Claims Examiner
Only for registered members Tampa, FL , Tampa, FL, US
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Claims Adjuster/ Claims Examiner
Only for registered members Tampa
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Claims Adjudicator/Examiner
Only for registered members Tampa
-
Claims Examiner Trainee
Full time Only for registered members Tampa
-
Claims Examiner Trainee
Only for registered members Tampa, FL
-
Claims Examiner Trainee
Only for registered members Tampa
-
Claims Examiner Trainee
Only for registered members Tampa
-
Claims Examiner, PIP
Only for registered members Tampa
-
Commercial Claims Examiner
Only for registered members Tampa, FL , Tampa, FL, US
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Liability Litigation Claims Examiner
Only for registered members Tampa, FL , Tampa, FL, US
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Commercial Litigation Claims Examiner
Only for registered members Tampa, FL
-
Workers Compensation Claims Examiner II
Only for registered members St. Petersburg
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Claims Manager
Only for registered members Clearwater
-
Claims Manager
Only for registered members Clearwater
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Health Insurance Claims Adjuster
Only for registered members Clearwater
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Claims Manager
Only for registered members Clearwater
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Health Insurance Claims Adjuster II
Only for registered members Clearwater