Claim Examiner / Orlando FL 32822

Mindlance; Orlando (FL); On-site; USD 42,000 - 62,000; Full time

Job summary

A national recruiting company is seeking a detail-oriented Business Claim Examiner in Orlando, Florida. The role involves verifying claims submissions, ensuring accuracy, and navigating multiple platforms. Strong data entry skills and a moderate knowledge of drugs are essential. Candidates should be available for a contract of 6 months, with working hours between Monday and Friday. This position offers a negotiable pay scale.

Qualifications

• Verify member submitted claims forms and eligibility accurately.
• Provide accurate and timely processing of claims.
• Navigate multiple platforms for claim submission.
• Strong communication skills for internal and external stakeholders.
• Ability to analyze claims for potential fraud by member or pharmacy.
• Efficient time management to handle daily workload and meet turnaround times.

Responsibilities

• Process claims according to client guidelines.
• Communicate with internal departments to resolve issues.
• Analyze claims for potential fraud.
• Communicate with members, pharmacies, and agencies to resolve claim issues.
• Assist in monitoring for potential fraud and ensure data integrity.

Skills

High data entry proficiency

Moderate knowledge of drugs and drug terms

Strong communication skills

Communication skills

Fraud analysis

Time management

Attention to detail

Claims research

Problem solving

Job description

Mindlance is a national recruiting company which partners with many of the leading employers across the country. Feel free to check us out at http://www.mindlance.com.

Job Description

Business Claim Examiner

Division Pharmaceutical

Pay Negotiable

Contract 6 Month

Timings Mon - Fri between 8.00AM – 5.00PM

Qualifications

POSITION OVERVIEW

• Verify member submitted claims forms, member's eligibility & pharmacy information is complete & accurate, updating system information as needed.
• A high data entry proficiency is expected in order to provide accurate & timely processing of claims submitted by member, pharmacy or agencies.
• Moderate knowledge of drugs & drug terms used daily.
• Process claims according to client specific guidelines while identifying claims requiring exception.
• Navigate daily through several platforms to research & finalize claim submissions.
• Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.
• Adhere to strict HIPPA regulations especially when communicating to others outside of ESI.
• Prioritize & coordinate influx of daily workload for claims processing, returned mail & outgoing correspondence & e-mails to assure required turnaround time is met.
• Assess accuracy of system adjudication & alert management of potential problems affecting the integrity of claim processing.
• Analyze claims for potential fraud by member or pharmacy.
• May be required to work on special projects for claims team.

If you are available and interested then please reply me with your “Chronological Resume” and call me on (678)-405-3590 .

Additional Information

Thanks & Regards,