Claims Examiner I — Growth Path & Benefits

capitalhealth; Tallahassee (FL); On-site; USD 38,000 - 48,000; Full time

Benefits offered by this job

Health coverage

Dental insurance

PTO

Retirement plan

Disability insurance

Life and AD&D insurance

Employee assistance program

SmartDollar

Job summary

Capital Health Plan in Tallahassee, FL seeks a full-time Claims Examiner I to review, evaluate, and process insurance claims per departmental policies and member benefits. The role requires attention to detail, accurate communication, and adherence to timelines.

The position offers a standard Monday–Friday schedule with potential evenings, weekends, and overtime as directed. Benefits include comprehensive health coverage, retirement plans, and PTO.

Qualifications

• High school diploma or equivalent, or related experience
• Ability to read and interpret manuals and procedures
• Ability to write routine reports
• Basic math skills and ability to compute rates
• Familiarity with claim processing and regulations
• Ability to communicate effectively with customers and employees
• Ability to meet and maintain guidelines for timeliness and accuracy of claims processing
• Knowledge of medical terminology and codes

Responsibilities

• Review and adjudicate insurance claims for accuracy and compliance with policy and provider agreements
• Follow up on pending claims and resolve issues with other departments
• Perform data validation on scanned/OCR claims and enter paper claims
• Issue appropriate denial notifications when needed
• Meet production and quality standards and progress to more complex claims

Skills

Customer service

Communication

Attention to detail

Math skills

Problem solving

Written communication

Education

High school diploma

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Adobe Acrobat

Job description

Capital Health Plan in Tallahassee, FL seeks a full-time Claims Examiner I to review, evaluate, and process insurance claims per departmental policies and member benefits. The role requires attention to detail, accurate communication, and adherence to timelines.

The position offers a standard Monday–Friday schedule with potential evenings, weekends, and overtime as directed. Benefits include comprehensive health coverage, retirement plans, and PTO.