Claims Processing, Communication Skills, Computer Skills, Computer Systems, Current Procedural Terminology (CPT), Customer Relations, Data Entry, Hospital Administration, International Classification of Diseases (ICD), Interpersonal Skills, Managed Care, Medical Terminology, Microsoft Access Database, Microsoft Excel, Microsoft Office, Microsoft Word, Organizational Skills, Policy Development, Presentation/Verbal Skills, Time Management
Claims Examiner II
Job Ref: TE0165
Category: Claims
Department: CLAIMS
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $54,000.00 - $64,474.00
Position Overview
The ideal candidate will have experience processing healthcare claims in a high-volume Claims Department. Must be computer literate and have ability to enter data into computer system with speed and accuracy. Must be able to demonstrate time management and strong organizational skills.
Scope of Role & Responsibilities
- Process all claims identified as exceeding claim age parameters established within the unit (28+ days)
- Process complex, difficult, and non-routine claims for multiple lines of business
- Audit work of assigned claims examiners to ensure accuracy.
- Identify policies of common errors requiring retaining sessions
- Assist with retraining sessions as directed.
- Participate in quality projects as required by management.
Required Education, Training & Professional Experience
- Bachelor's degree is required; a Master's degree is preferred, or an equivalent combination of education and relevant experience that demonstrates satisfactory equivalency.
- At least three (3) years' experience of claims in a managed care or hospital setting is required.
- Strong data entry skills are essential.
- In-depth knowledge of adjustment processing, medical terminology, CPT, ICD‑P, and revenue codes is required.
- Proficiency in Microsoft Office applications, including Word, Excel, and Access, is required.
- Must be capable of performing all duties and responsibilities of Claims Examiners within the department.
Professional Competencies
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
- Must be able to communicate adequately both verbal & written
- Must have excellent interpersonal skills
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Metroplus Health Plan Inc