Claim Examiner I

Medical Claims Processor

Location : Calmont Operations Building

Department : Claims

Shift : First Shift (United States of America)

Standard Weekly Hours : 40

Summary : This position is responsible for processing medical insurance claims accurately and in a timely manner to ensure state regulations are met. Consistently meet established productivity and quality standards.

Additional Information : This position is responsible for processing medical insurance claims accurately and in a timely manner to ensure state regulations are met. Consistently meet established productivity and quality standards.

Education :

• High School diploma or equivalent
• 2-3 years experience in a medical claims processing environment.
• Must be extremely detail-oriented, precise, and thorough.
• Extensive knowledge of medical claim processing procedures and guidelines.
• Ability to work independently while providing support to a team environment.
• Knowledge of medical benefits and medical terminology.
• Must have strong organizational skills, problem solving, and decision making skills.
• Knowledge of claim adjudication and benefit plan application for Texas Medicaid.
• Able to process adjustments as needed.
• Knowledge of Microsoft Office Skills including Word, and Excel.

About Us : Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

Cook Children's is an equal opportunity employer. As such, Cook Children's offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.