Claims Examiner

Join a healthcare organization dedicated to operational excellence and accurate claims processing. This role is essential in ensuring timely and precise adjudication of provider claims while maintaining compliance with healthcare guidelines and policies.
Responsibilities:

* Process medical and surgical claims, ensuring complete and accurate member and provider information
* Adjudicate claims within established guidelines and authorize final claim disposition
* Apply administrative policies and claims processing procedures as needed
* Review claims for accuracy, validity of charges, and potential errors
* Evaluate pended claims related to contractual or payment discrepancies
* Generate correspondence to providers requesting additional information when necessary
* Maintain productivity and quality standards established by the department
* Update reference materials and participate in training sessions
* Track individual production metrics...