Claim Examiner 1

Claims Examiner I

The Claims Examiner I is responsible for inbound calls from providers and health plans and adjudicates physician claims, in a timely and accurate manner. Provides superior customer service consistent with company standards and goals, including inbound calls from providers and health plans. Responsible for quality and continuous improvement within the job scope. Also responsible for all actions / responsibilities described in company-controlled documentation for this position. Contributes to and supports the corporation's quality improvement efforts.

Processes medical claims (CPT, ICD, and Revenue Coding) at production standards, including timely follow-up on inquiries received and correctly logs all incoming calls and emails. Maintains the minimum accuracy standard and follows up timely to meet compliance standards for claims, pends, and tasks. Reviews claim images and batches to ensure accuracy.

Uses proper plan documentation to determine benefits and correctly adjudicate. Meets and maintains the minimum production in addition to completing reports and projects given by the supervisor. Effectively participates in meetings, training, and committees as designated by the supervisor. Reviews feedback from supervisors, trainers, auditors, examiners, and trending spreadsheets. Identifies and implements required steps for improvement.

Minimum Qualifications

One year of claims processing, claims logging, or customer service experience in a managed care environment. - and - Demonstrated minimum of 100 SPM on ten key and 30 WPM typing.

Preferred Qualifications

Associates degree or some college level coursework. Degree obtained from accredited institution. Education is verified. - and Demonstrated excellent verbal, written, and interpersonal skills. - and - Demonstrated consistent accuracy and processing efficiency in work. - and - Demonstrated ability to resolve complex claims problems and be detailed oriented.

Physical Requirements

Manual dexterity, hearing, seeing, speaking.

Location : Central Office - Las Vegas

Work City : Las Vegas

Work State : Nevada

Scheduled Weekly Hours : 40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$18.93 - $27.45

We care about your well-being mind, body, and spirit which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.