Top 2 Claims examiner Jobs in Winston Salem, Nc

Medical Claims Examiner
Actuarial Management Resources, Inc. —Winston-Salem, NC
- From $19.58 an hour
- Full-time
- Hybrid work
- 5 years
- HIPAA
- Mid-level
- Health insurance
- 401(k)
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6d

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Medical Claims Examiner
Actuarial Management Resources, Inc. —Winston-Salem, NC
Answer phones and communicate with caller; estimated 5-20 calls per day. Maintain client files and confidentiality with excellent documentation and organization…
From $19.58 an hour
Quick Apply
6d
Senior Claims Examiner
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Relevant professional licenses and/or certifications, including a North Carolina insurance adjuster license. The primary purpose of this role is to investigate,…

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A valid driver’s license will be required for driving positions only. As a condition of employment, applicants will be subject to a background investigation in…
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Account Examiner 2 - (PN: 20067467)
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There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.
$23.65 an hour
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Medical Claims Examiner

Actuarial Management Resources, Inc.
Winston-Salem, NC

Quick Apply

Job Details

Full-time
From $19.58 an hour
6 days ago

Benefits

Health insurance
401(k)
Paid time off
Life insurance

Qualifications

Client relationship management
Customer communication
Customer relationship building
HIPAA
Filing
Microsoft Office
High school diploma or GED
Customer service problem-solving
Documentation review

Full Job Description

Job Overview
The Medical Claims Examiner will be responsible for handling several blocks of moderate to complex claims. The Medical Examiner is accountable for ensuring optimal claims handling and timely, accurate decisions. A strong customer focus is required to maintain customer relationships. The Medical Examiner will interact with internal and external customers including, but not limited to, claimants, employers, physicians, attorneys, etc., to gather the information to make the decision on the claim. The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the contract.

Starting Pay Rate $19.58

Full Time or Part Time: Full Time

Standard Hours per Week: Monday – Friday, 40 hours/week Work Schedule: Shift starts 8:00 AM – 5:00 PM

Schedule Type: In office with hybrid flexibility after training

Responsibilities

Analyze insurance contract documents and systems to ensure provisions are applied correctly.
Confidently evaluate and adjudicate multiple complex claim types and medical records.
Gather and review medical, financial, and occupational information pertaining to the claim.
Communicate clearly with the insured and/or provider routinely to provide statuses and to request information.
Input sensitive information into the claim system while ensuring accuracy.
Ability to solve complex claim scenarios, and the ability to manage multiple and changing priorities
Demonstrate tenacity and independence with assigned claim work.
Draft free-form letters involving complex subject matters. Strong emphasis on polished and professional communications. Communication may be verbal or written (paper and/or electronic).
Adhere to insurance regulations and internal service level standards. Review for potential fraud.
Maintain client files and confidentiality with excellent documentation and organization of data filing while insuring to maintain HIPAA laws and regulations.
Answer phones and communicate with caller; estimated 5-20 calls per day.
Proven skills in positive and effective interaction with challenging customers
Stay updated on industry trends, best practices, and product/service updates through training sessions, self-study, and team meetings to enhance knowledge and performance

Job Requirements

Basic Qualifications

5 or more years’ experience in insurance claims experience.
Advanced analytical and problem-solving skills.
Demonstrated proficiency using Microsoft systems.
Strong written and verbal communication skills.

Other Qualifications

General understanding of Medical and Disability operations.
General medical knowledge and investigative skills.
Advanced understanding of policy coverages including, disability, medical and waiver riders
Entering confidential data into claims system.
Monitoring reports to ensure adherence to internal service level standards.
Interacting with claimants and insurance carriers as needed.
Adjudicating moderate to complex claims.
High School Diploma/GED

Job Type: Full-time

Pay: From $19.58 per hour

Benefits:

401(k)
Health insurance
Life insurance
Paid time off

Education:

High school or equivalent (Required)

Location:

Winston-Salem, NC 27106 (Required)

Work Location: In person

Quick Apply

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Medical Claims Examiner

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