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Medical Claims Associate

Green Key Resources Meridian, ID
  • Expired: over a month ago. Applications are no longer accepted.
Job Description

We are looking for a Medical Claims Specialist to join our insurance team in the Meridian, ID area.

Position Type: 6 month contract, likely to extend.

Requirements for Medical Claims Specialist :

  • Six months claims or customer service related work experience in the health insurance industry; or
  • 18 months work experience in a general office or medical office environment
  • Knowledge of: Medical Terminology, Ten Key, Coding, health claims processing

POSITION PURPOSE:

To assure accurate and timely claims processing within corporate standards for all contracts processed in the Traditional Claims Unit.

Responsibilities for Medical Claims Specialist :

  • Consistently ensure timely and accurate acceptance of claims through the review of claim history and edit or deferral reports including the simple manual computation of benefits, both in- and out-of-network, by entering data using available resource materials such as contracts, contract benefit files, etc. Refer questionable and non-routine claims to more experienced personnel.
  • Access online policies, procedures, manuals, contracts, e-mails received through Outlook,etc., and stay current on all other information related to benefit administration
  • Recognize and report problems and potential errors in network, fee schedule, or other plan systems.
  • Analyze the reasons for the edits of the claims data and take appropriate action needed to process claims, including directing claims to Medical Management for medical determinations.
  • Recognize, investigate, and report immediately any abnormal or aberrant claim practices or system configuration issues to the Supervisor or Senior Claim Examiner for review.
  • Recognize incorrectly processed claims in the member’s history, watching for cascade errors on all previously processed claims and creating and intake for appropriate personnel.
  • Develop and employ inventory evaluation skills using good time management.
  • Record and submit accurate work hours and time exceptions in designated applications or operating systems.
  • Monitor individual quality and efficiency daily using online tools..

Next Steps for Medical Claims Specialist!

Looking to interview immediately. If you feel that you meet these requirements and are interested, please APPLY

Company Description
Premier executive recruitment firm specializing in permanent placement, contract consulting, temp-to-hire and temporary staffing within the following specialty areas: accounting-finance, healthcare nursing & allied health, pharmaceutical, financial service operations, information technology, creative, hospitality, office/legal support and human resources across our offices nationwide.

Our recruiters are highly-specialized consultants who only recruit within specific job disciplines. Each of our division leaders has over a decade of direct experience working in the industries they serve. The bottom line is that we understand your business, your challenges – and most importantly what it takes to source and successfully hire top talent. When you’re looking to hire people who make an immediate impact, unlock your potential with Green Key Resources.

Green Key Resources

Premier executive recruitment firm specializing in permanent placement, contract consulting, temp-to-hire and temporary staffing within the following specialty areas: accounting-finance, healthcare nursing & allied health, pharmaceutical, financial service operations, information technology, creative, hospitality, office/legal support and human resources across our offices nationwide. Our recruiters are highly-specialized consultants who only recruit within specific job disciplines. Each of our division leaders has over a decade of direct experience working in the industries they serve. The bottom line is that we understand your business, your challenges – and most importantly what it takes to source and successfully hire top talent. When you’re looking to hire people who make an immediate impact, unlock your potential with Green Key Resources.

Address

Meridian, ID
USA

Website