CLAIMS EXAMINER

ADP, Inc.; Fort Scott (KS); On-site; USD 38,000 - 60,000; Full time

Job summary

ADP, Inc. is seeking a Claims Examiner for a full-time clerical role. You will evaluate and determine coverage for benefits based on the member’s plan and client processing guidelines, while maintaining quality and production standards.

The position requires a high school diploma or GED, plus at least one year of claims adjudication or medical billing experience. Strong attention to detail and effective communication are essential, along with HIPAA compliance and teamwork.

Qualifications

• High school diploma or GED required.
• One year of claims adjudication experience or equivalent medical billing office experience preferred.
• Medical terminology and medical claims coding knowledge preferred.

Responsibilities

• Evaluate and determine coverage for benefits based on the member’s plan/client’s processing guidelines.
• Maintain quality and production standards as defined by client contract and/or management determination of need.
• Manage time adequately to ensure proper turnaround for all tasks (new claims, pending claims, customer service requests, audits).
• Work with teammates and supervisor to meet client needs.
• Assist in development of process improvement initiatives.
• Look at processes and suggest hot keys and efficiencies.

Skills

Attention to detail

Effective communication

Reading comprehension

Basic math skills

HIPAA compliance

Teamwork

Schedule flexibility

Medical terminology

Medical claims coding

Education

High school diploma or GED

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

CLAIMS EXAMINER

Full Time Clerical

30+ days ago Requisition ID: 1002

Responsibilities:

• Evaluate and determine coverage for benefits based on the member’s plan/client’s processing guidelines.
• Maintain quality and production standards as defined by client contract and/or management determination of need.
• Manage time adequately to ensure proper turn around for all tasks such as new claims, pending claims, customer service requests and audit feedback.
• Work with teammates and supervisor to ensure the needs of the client are being met.
• Assist in development of process improvement initiatives.
• Ability to look at processes and offer suggestions for hot keys and efficiencies.

Accountabilities:

• Successfully completes all training programs as required.
• Acts in accordance with all HIPAA Privacy and Security guidelines to ensure confidential handling of protected health information.
• Execute prompt analytical decision making/research with specific attention to detail.
• Comply with State laws, policy and company procedures.
• Utilize specified claims production tracking and reporting procedures.

Education & Experience:

• High school diploma or GED
• One year of claims adjudication experience or equivalent medical billing office experience is preferred.

Language Requirements:

• Read and comprehend instructions, discussion, correspondence and memos.
• Hold a conversation and communicate ideas in an understandable manner.
• Medical terminology and medical claims coding knowledge is preferred.

Physical Requirements:

• Light repetitive movement of digits.
• Stationary 80% of time at a work station keying and viewing a computer screen.
• Moving, positioning, and reaching intermittently.

Other Requirements:

• Must be able to maintain confidentiality.
• Must be detailed oriented.
• Must have ability to stay focused.
• Must have basic math skills.
• Must have reading comprehension skills to read and apply the provisions of specific plan documents.
• Must have ability to work in a windows environment on a PC.
• Must have effective communication skills.
• Must be able to work in a team environment.
• Must be flexible with schedule, including working more or less than a 40 hour week when client inventory levels fluctuate.