Top 22 Claims examiner Jobs in Countryside, Il

Claims Examiner
Midwest Operating Engineers Fringe Benefit Fund —Countryside, IL
- $33.23 an hour
- Full-time
- Anatomy knowledge
- HIPAA
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
6d
Benefit Claims Examiner
Illinois Municipal Retirement Fund (IMRF) —Oak Brook, IL
- $53,369 - $58,705 a year
- Monday to Friday
- Basic math
- Mid-level
- Office
- Paid holidays
- Disability insurance
13d
Claims Examiner
Marsh McLennan Agency —Schaumburg, IL
- $54,700 - $101,900 a year
- Full-time
- Hybrid work
- 5 years
- Bachelor of Science
- Bachelor's degree
- Health insurance
- Dental insurance
6d
Senior Claims Examiner
Markel Service Inc. —Rosemont, IL
- $78,000 - $107,250 a year
- Email
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- 5 years
- AD&D insurance
- Employee stock purchase plan
Quick Apply
10d
Claims Examiner II - Marine Personal Lines
Markel Service Inc. —Chicago, IL
- $62,000 - $85,800 a year
- Email
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- AD&D insurance
- Employee stock purchase plan
Quick Apply
4d
Claim Examiner II, Construction
Markel Service Inc. —Rosemont, IL
- $62,400 - $85,800 a year
- Email
- Hybrid work
- Customer service
- Mid-level
- Office
- AD&D insurance
- Employee stock purchase plan
Quick Apply
5d
Senior Workers' Compensation Claims Examiner - Federal Claims
AIG Claims, Inc. —Chicago, IL
- $73,000 - $96,000 a year
- Email
- Customer service
- Writing skills
- Office
- Health insurance
Quick Apply
Executive Claims Examiner, Miscellaneous Professional E&O
Markel Service Inc. —Rosemont, IL
- $97,520 - $134,090 a year
- Email
- Writing skills
- Mid-level
- Travel
- AD&D insurance
- Employee stock purchase plan
Quick Apply
10d
Executive Claims Examiner, Programs
Markel Service Inc. —Chicago, IL
- $97,520 - $134,090 a year
- Email
- Hybrid work
- Writing skills
- Team management
- Travel
- AD&D insurance
- Employee stock purchase plan
Quick Apply
10d
Senior Claims Examiner, Construction
Markel Service Inc. —Rosemont, IL
- $78,000 - $107,250 a year
- Email
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Customer service
- AD&D insurance
- Employee stock purchase plan
Quick Apply
10d
Senior Claims Examiner, Excess Construction
Markel Service Inc. —Rosemont, IL
- $78,000 - $107,250 a year
- Email
- Hybrid work
- 7 years
- Microsoft Excel
- Microsoft Outlook
- AD&D insurance
- Employee stock purchase plan
Quick Apply
6d
Senior Claims Examiner, Ocean Marine Claims
Markel Service Inc. —Rosemont, IL
- $78,000 - $107,250 a year
- Email
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- 5 years
- AD&D insurance
- Employee stock purchase plan
Quick Apply
10d

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Workers Compensation Claims Examiner | MI, KY, IN & OH Jurisdictions | MI, IN & KY Licensing Preferred
Sedgwick —Dublin, OH
Professional certification as applicable to line of business preferred. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting,…
7d

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claims examiner jobs near countryside, il

Claims Examiner

Midwest Operating Engineers Fringe Benefit Fund
Countryside, IL

Quick Apply

Job Details

Full-time
$33.23 an hour
6 days ago

Benefits

Health insurance
Dental insurance
Paid time off
Employee assistance program
Retirement plan

Qualifications

Customer communication
Anatomy knowledge
Copy machines
Health insurance policy knowledge
Medical coding guidelines
Medical claims processing software
High school diploma or GED
Productivity software
Medical terminology
Cross-functional communication
DRG

Full Job Description

Summary/Objective:

This position is responsible for analyzing and processing facility, ancillary and physician claims, checking them for validity. Medical claims examiner reviews claims for various items, including appropriate billing practices, and coverage based on the Health and Welfare Guidelines. The Examiner must possess knowledge of medical terms, such as Current Procedural Terminology (CPT), Health Care Procedure Coding Systems (HCPCS) and International Classification of Diseases (ICD-10) to review the claim accurately.

Essential Functions

Validate information on all medical claims from members and providers seeking payment from their benefits.
Request required information from both internal and external sources to establish whether the claim is complete and valid.
Ability to examine different types of claims (ie: electronic, paper, dental, member reimbursements, etc.)
Exercise prudent judgement to determine when claims require repricing, case management review, or additional information.
Communicate effectively with Leadership, cross departments, members, providers, and vendors to expediently handle claim issues.
Follow appropriate HIPAA guidelines related to patient privacy and confidentiality.
Attend and participate in Claims Department meetings for training purposes.
Meet and maintain production and quality standards.
Ability to navigate through multiple vendor portals.
Test and verify new or enhanced system applications, if necessary.
Examine a claim using plan document, schedule of benefits, supporting documentation, Knowledge Articles, and other resources to make reasonable decisions regarding proper payment of claims.

Identify order of payment for coordination of benefits with other insurance companies.
Identify eligibility issues.

Identify billing trends and/or industry changes to notify management.
Collaborate with other team members, sharing knowledge and processing techniques.
Create and maintain Knowledge articles.
Other duties as assigned.

Education and Experience

High School diploma or G.E.D. Certificate.

Specialized skills/technical knowledge required:

Understand Plan eligibility and payment rules including excluded and included covered benefits.
Must have general medical terminology and anatomy knowledge.
Must be able to handle a high quality and production environment.
Be able to communicate effectively and professionally in all areas of communication.
Knowledge of healthcare coding systems and methodologies such as CPT, ICD-10 and DRG.
Must have strong organizational, and problem-solving skills.
Must be a team player.
Proficient in Microsoft Office applications.
Ability to handle multiple tasks in a fast-paced environment.
Ability to read and interpret medical records preferred, but not mandatory.
Ability to work independently as well as, with others to meet deadlines and resolve any outstanding processing issues.
Must be detailed oriented.
Must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier, and telephone.
Knowledge of ISSI or similar claim processing systems.
Knowledgeable of Salesforce is preferred, but not necessary.

Job Type: Full-time

Pay: $33.23 per hour

Expected hours: No less than 40 per week

Benefits:

Dental insurance
Employee assistance program
Health insurance
Paid time off
Retirement plan

Schedule:

Day shift
Monday through Friday (Some Saturdays may be required)

Work Location: In person

Quick Apply

Refine Your Search

claims examiner jobs in countryside, il

Claims Examiner

Benefit Claims Examiner

Claims Examiner

Senior Claims Examiner

Claims Examiner II - Marine Personal Lines

Claim Examiner II, Construction

Senior Workers' Compensation Claims Examiner - Federal Claims

Executive Claims Examiner, Miscellaneous Professional E&O

Executive Claims Examiner, Programs

Senior Claims Examiner, Construction

Senior Claims Examiner, Excess Construction

Senior Claims Examiner, Ocean Marine Claims

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