Claims Examiner III

American Specialty Health, Inc. is seeking a Claims Examiner III for our Claims department.  The primary purpose of this position is to enter data from CMS 1500 Claim Forms into the Claims Processing System for all accounts.  This position is responsible for the accurate review, input and adjudication of claims in accordance with regulations, ASH standards and contractual obligations of the organization

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Responsibilities

  • Processes claims accurately and efficiently
  • Reviews all incoming claims to verify necessary information.
  • Enters claims data and information into the computerized Claims Processing System.
  • Maintains all required documentation of claims processed and claims on hand.
  • Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.
  • Maintains production standard; processes an average of 37 claims per hour, with an accuracy rate of 99% over each pay period.
  • Provides backup for other examiners within the department.
  • Assists in training of new claims personnel.
  • Promotes a spirit of cooperation and understanding among all personnel.
  • Attends organizational meetings as required.
  • Adheres to organizational policies and procedures.
  • Maintains confidentiality of all claims files, claims reports, and claims related issues.

Qualifications

  • High school diploma required.
  • Minimum 1.5 years data entry experience with 10 key and word processing; minimum 10,000 key strokes per hour required. 
  • Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.
  • Proficient in MS Office.
  • Minimum of 6 months as a Claims Examiner Level II with proven ability to meet all requirements as defined in the Career Path Progression for Examiners for >=6 months

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Core Competencies

  • Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
  • Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
  • Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
  • Ability to effectively organize, prioritize, multi-task and manage time.
  • Demonstrated accuracy and productivity in a changing environment with constant interruptions.
  • Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
  • Ability to exercise strict confidentiality in all matters.

Mobility

Primarily sedentary, able to sit for long periods of time. 

Physical Requirements

Ability to speak, see and hear other personnel and/or objects.  Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard.  Ability to lift up to 10 lbs.

Environmental Conditions

Usual office setting.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law. 

Please view Equal Employment Opportunity Posters provided by OFCCP here.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.

ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.