Experience: Mid Level
Salary: $24 - $28 per hour
Job Details
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Job Details
We are seeking a dynamic and experienced Consulting Claims Examiner III to join our growing team in the healthcare industry. This position requires an individual who is detail-oriented, highly analytical, and adept at handling a high volume of claims. The successful candidate will be responsible for the accurate and timely data entry, review, and adjudication of professional, ancillary, and institutional claims for services rendered in various healthcare settings. This role requires a deep understanding of regulatory guidelines, contract provisions, and established policies and procedures. The incumbent will be responsible for meeting quality, productivity, service-level, and turn-around requirements in accordance with the department’s performance standards and regulatory requirements.
Responsibilities
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Accurate and timely data entry, review, and adjudication of all types of healthcare claims.
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Ensuring compliance with regulatory guidelines, contract provisions, and established policies and procedures.
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Meeting quality, productivity, service-level, and turn-around requirements.
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Receiving work assignments via batch, report, in-basket pools, work queues, or other methods.
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Researching and resolving complex claim issues.
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Training others on claims processes and workflows.
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Collaborating with other departments to ensure the accuracy of claims processing and resolve any discrepancies.
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Continuously updating knowledge on industry trends and regulations to ensure the company's compliance.
Qualifications
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5+ years of experience in claims examination, preferably in the healthcare industry.
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Proficient in data entry, review, and adjudication of healthcare claims.
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Strong knowledge of regulatory guidelines, contract provisions, and established policies and procedures related to healthcare claims.
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Excellent analytical skills with the ability to research and resolve complex claim issues.
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Proven experience in meeting quality, productivity, service-level, and turn-around requirements.
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Strong training skills with the ability to effectively train others on claims processes and workflows.
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Excellent communication and interpersonal skills.
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Strong computer skills, including proficiency in Microsoft Office Suite and claims management software.
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Ability to work independently and collaboratively within a team environment.
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Bachelor's degree in healthcare administration, business, or a related field is preferred.
A bit about us:
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Prestige Hospital System
Advancing new knowledge and improving health outcomes through research
Why join us?
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Competitive compensation
Medical Insurance
Dental Insurance
Vision Insurance
Life Insurance
Flexible Schedule
Job Stability
Career growth
If you are passionate, thrive in a fast-paced environment and are ready to take your career to the next level, we would love to hear from you.
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