[Hiring] Claims Examiner I @Florida Blue

Role Description

As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity.

• Day-to-day processing of claims for accounts
• Responsible for processing of claims (medical, dental, vision, and mental health claims)
• Claims processing and adjudication
• Claims research where applicable
• Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic)
• Meet and/or exceed qualitative and quantitative production standards
• Investigation and overpayment administration
• Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers
• Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records
• Utilize systems to track complaints and resolutions
• Resolve claims appeals, research benefits, verify correct plan loading

Qualifications

• 2+ years related work experience
• Medical claims and adjudication experience on a computerized claims payment system in the healthcare industry
• High school diploma or GED
• Knowledge of medical coding, CPT, ICD10, COBRA, HIPAA, pre-existing conditions, and coordination of benefits
• Experience with multiple surgical procedures and establishment of reasonable and customary fees
• Medical billing and coding courses are a plus
• Experience in processing all types of medical claims helpful

Benefits

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan includes employer contribution and employer match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available and a comprehensive wellness program

General Physical Demands

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.