Claims Examiner
Company: Benefit & Risk Management Services Inc.
Location: Sacramento
Posted on: January 27, 2023
Job Description:
Job DescriptionSummary: The Claims Examiner is responsible for
ensuring claims are coded and processed correctly and for meeting
production requirements. Processes claims by performing the
following duties.Essential Duties and Responsibilities include the
following. Other duties may be assigned.
- Comprehensive understanding of employee benefits for medical,
dental and vision plans.
- Compares data on claim application with policy file and other
company records to ascertain completeness and validity of
claim.
- Ensures all claims are coded properly.
- Maintains high quality standards to avoid paying claim
incorrectly.
- Maintains productivity standards set by Lead or manager.
- Contacts doctors, lawyers, or others involved to resolve
claim/coverage questions.
- Examines claim adjustors' reports or similar claims/precedents
to determine extent of coverage and liability.
- Corresponds with agents and claimants to correct errors or
omissions on claim forms, and to investigate questionable
entries.
- Refers most questionable claims to investigator or to claim
adjuster for investigation and settlement.
- Researches paid and denied claims received from Customer
Support and reply as needed.
- Performs other duties and responsibilities as assigned by
ManagementSupervisory Responsibilities: This job has no supervisory
responsibilities.Qualifications: To perform this job successfully,
an individual must be able to perform each essential duty
satisfactorily. The requirements listed below are representative of
the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions.**Must have 3-5 yrs industry
experience**Education and/or Experience: Associate's degree (A. A.)
or equivalent from two-year college or technical school; or 3-5
years related experience and/or training; or equivalent combination
of education and experience.Knowledge, Skills, & Abilities:
- Excellent written and verbal communication skills.
- Strong analytical skills and problem-solving skills.
- Must be dependable and maintain excellent attendance and
punctuality
- Subject-matter expert within field.
- Must be able to perform data entry operations quickly and
accurately.
- Ability to grow with changing demands of the position and the
company.
- Strong computer skills, including Word, Excel, and
Outlook.
- Must be highly proficient in ICD-9, CPT, and HCPCS codes.
- Background Required. Language Skills: Ability to read, speak,
and write effectively in English. Ability to interpret documents
such as safety rules, operating and maintenance instructions, and
procedure manuals. Ability to write routine reports, meeting notes,
project documentation, and correspondence. Ability to speak
effectively before customers or employees of organization. Ability
to effectively address or resolve customer service issues within
guidelines of the position.Mathematical Skills: Ability to add,
subtract, multiply, and divide in all units of measure, using whole
numbers, common fractions, and decimals. Ability to compute rate,
ratio, and percent and to draw and interpret bar graphs.Reasoning
Ability: Ability to apply common sense understanding to carry out
instructions furnished in written, oral, or diagram form. Ability
to deal with problems involving several concrete variables in
standardized or non-standardized situations.Certificates, Licenses,
Registrations: Valid, class C license in state working with no
adverse driving recordPhysical Demands: The physical demands
described here are representative of those that must be met by an
employee to successfully perform the essential functions of this
job. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions. While
performing the duties of this Job, the employee is regularly
required to sit for extended periods in front of a computer. The
employee is frequently required to reach with hands and arms and
talk or hear. The employee is occasionally required to stand; walk
and use hands to finger, handle, or feel. The employee may
frequently lift and/or move up to 10 pounds. Specific vision
abilities required by this job include close vision, distance
vision, peripheral vision, depth perception and ability to adjust
focus. This position requires the employee to work in the
office.Work Environment: The work environment characteristics
described here are representative of those an employee encounters
while performing the essential functions of this job. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions. The noise level in the work
environment is usually moderate.Company DescriptionEstablished in
1993, Benefit & Risk Management Services, Inc. (BRMS) is a leading
benefit administrator and healthcare risk manager that delivers
innovative technology and administration solutions to control
rising healthcare costs.One of the first to introduce employee
benefit administration technology solutions, our services are
powered by our exclusive Virtual Benefits Administration System
(Vbas) a proprietary database and administration system that allows
employers to save time and money by automating management of the
benefit supply chain and empowering employees to self-service their
benefitsby Jobble
Keywords: Benefit & Risk Management Services Inc., Sacramento , Claims Examiner, Other , Sacramento, California
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