Claims Examiner - Jefferson Health Plan

Thomas Jefferson University • Philadelphia, PA

1d

About The Position

Working under general supervision, the Claim Examiner adjudicates medical claims, in accordance with Health Partners' policies and procedures. Job Description Able to work in a constant state of alertness and safe manner Accurately adjudicates claims in compliance with data entry rules, On Line Processing Rules and contractual agreements. Reviews pended claims on a daily basis, assuring that all appropriate documentation is completed before adjudication. Accurately completes service forms for pended claims and routes to designated areas for resolution. Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes. Follow established procedures and guidelines for claims processing and high dollar claim review. Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy. Keeps current with Claims Department policies and procedures. Assist the unit in meeting and maintain performance standards.

Requirements

• High School Diploma/GED
• Ability to maintain strict confidentiality of patient information obtained in the performance of job function

Nice To Haves

• 2 years claims processing experience or provider billing experience
• Excellent communication skills required-both oral and written
• Basic understanding of computer applications
• General understanding of the principles of Managed Care

Responsibilities

• Accurately adjudicates claims in compliance with data entry rules, On Line Processing Rules and contractual agreements.
• Reviews pended claims on a daily basis, assuring that all appropriate documentation is completed before adjudication.
• Accurately completes service forms for pended claims and routes to designated areas for resolution.
• Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes.
• Follow established procedures and guidelines for claims processing and high dollar claim review.
• Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy.
• Keeps current with Claims Department policies and procedures.
• Assist the unit in meeting and maintain performance standards.

Benefits

• Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
• Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service.
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance.
• For more benefits information, please click here

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED