Claims Examiner

Auxiant; Madison (WI); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Flexible Spending

Gym membership reimbursement

Life Insurance

Long-term Disability

Short-term Disability

401K

3 weeks vacation

9 paid holidays

Casual dress code

Job summary

Auxiant in Madison, WI, is seeking a Claims Examiner to process medical claims and correspondence and handle customer service calls from members, providers, and clients.

You will analyze self-funded health plans, interpret plan language, and serve as the primary contact for clients and members while maintaining accuracy and timely communication.

Qualifications

• Familiarity with ICD-10 and CPT coding.
• Understanding of medical claims processing guidelines.
• Proficient PC skills including email, record keeping, routine database activity, word processing, spreadsheet and 10-key.
• Medical Terminology.
• High school diploma and 1–2 years related experience; or equivalent combination of education and experience.
• QicLink experience.

Responsibilities

• Process claims in a timely manner with acceptable accuracy.
• Answer inbound phone calls from members and providers.
• Handle correspondence from members and providers in a timely manner.
• Analyze self-funded health plans and use plan language to respond to inquiries, both verbally and in writing.
• Interpret plan design and language to analyze claim edits.
• Point of contact for clients and members.
• Work Customer Service Tickets.

Skills

ICD-10 and CPT coding familiarity

Medical Terminology

Medical claims processing guidelines

Proficient PC skills: email, records,

Education

High school diploma

Tools

QicLink

Job description

Description

https://www.auxiant.com/

Auxiant’s Mission Statement and Core Values

Mission:

An Independent TPA investing in People and Innovation to deliver expert-driven experiences with REAL Results.

Core Values:

Independent Solutions. REAL Results
Respect
Empowerment
Agility
Leadership

Be part of a growing and prospering company as a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans with offices in Cedar Rapids, IA, Madison and Milwaukee, WI. Auxiant is a fast-growing,progressive company offering an excellent wage and benefit package.

Job Summary:

Responsible for processing medical claims and correspondence and handling customer service calls from members, providers, and clients.

Essential Functions:

• Process claims in a timely manner with acceptable accuracy
• Answer inbound phone calls from members and providers.
• Handle correspondence from members and providers in a timely manner.
• Analyze self-funded health plans and use plan language to correspond to necessary inquiries, both verbally and written.
• Interpret plan design and language to analyze claim edits.
• Point of contact for clients and members.
• Work Customer Service Tickets.

Nonessential Functions:

• Other duties as assigned or appropriate

Education/Qualifications:

• Familiarity with ICD-10 and CPT coding
• Understanding of medical claims processing guidelines
• Proficient PC skills including email, record keeping, routine database activity, word processing, spreadsheet and 10-key
• QicLink experience
• Medical Terminology
• High school diploma and 1-2 years related experience; or equivalent combination of education and experience

*Full benefits including: Medical, Dental, Vision, Flexible Spending, Gym Membership Reimbursement, Life Insurance, LTD, STD, 401K, 3 weeks vacation, 9 paid holidays, casual dress code and more

Job Type: Full-time

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: In person