Job Description:
• Manage daily operations of the Claims Examiner team
• Assist with work distribution and individual performance tracking
• Measure competency and production levels
• Respond to technical questions from claims examiners
• Assist the supervisor in implementing new processes and procedures
• Perform auditing tasks
• Provide training to internal users on plan benefit matrix and claims policies/procedures
• Process claims and serve as a role model for staff
• Evaluate complex medical, dental, and behavioral health claims
• Provide excellent customer service to internal and external customers
• Document all activities using CareOregon's on-line phone tracking system
• Meet or exceed Department and Company policies including quality and production
• Identify trends and communicate findings and process improvement ideas to the supervisor
Requirements:
• Minimum 3 years’ experience as a medical claims processor in the health insurance industry
• Experience with people and/or project leadership
• In-depth knowledge of claims adjudication principles and procedures
• Advanced knowledge of CPT, HCPCS, Revenue, DPT and ICD-9 coding
• Strong knowledge of medical, dental, mental health and health insurance terminology
• Strong understanding of federal and state laws and other regulatory agency requirements that relate to the medical, dental, mental health and health insurance industry or Medicaid/Medicare industry
Benefits:
• Health insurance
• 401(k) matching
• Flexible spending account(s)
• Employee assistance program
• Wellness program
• Discounts
• Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings)
• Strong retirement plan with employer contributions
• Paid time off and Sick time
• Paid holidays
• Volunteer time
• Jury duty
• Bereavement leave
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Apply Now