Claims Examiner I–IV: Impact & Growth

Excellus Health Plan Inc.; DeWitt (MI); Hybrid; USD 28,000 - 45,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus Health Plan Inc. is seeking a Claims Examiner to process, adjudicate and adjust claims across Level I to Level IV. You will handle eligibility, claim entry and processing, identify trends, and escalate issues per policy.

The role requires handling complex transactions, maintaining privacy, and collaborating with internal teams. A NYS Independent Adjuster License is required at the specified level and willingness to grow with the role.

Qualifications

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Ability to navigate Windows environment and work across multiple programs.
• B Version: NYS Independent Adjuster License and renewal maintenance required.

Responsibilities

• Handle front end transactions including member eligibility, entry of claims and claim processing.
• Process, adjudicate and/or adjust and research claims per procedures.
• Identify patterns impacting quality or customer experience and escalate appropriately.
• Collaborate with internal departments and communicate risk to leadership when needed.

Skills

Customer service experience

Claims processing

Windows navigation

Multi-tasking

Education

High School diploma or equivalent

Job description

Excellus Health Plan Inc. is seeking a Claims Examiner to process, adjudicate and adjust claims across Level I to Level IV. You will handle eligibility, claim entry and processing, identify trends, and escalate issues per policy.

The role requires handling complex transactions, maintaining privacy, and collaborating with internal teams. A NYS Independent Adjuster License is required at the specified level and willingness to grow with the role.