Claims Examiner, Sr. jobs in Columbus, OH

Claims Examiner, Sr. reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner, Sr. studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner, Sr. determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner, Sr. occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Claims Examiner, Sr. typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)

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Claims examiner
  • UST
  • Columbus, OH FULL_TIME
  • Claims Examiner
    UST HealthProof is looking for Claims Examiner, reporting to the Claims Team Leader, the Examiner is responsible for adjudication of healthcare claims utilizing employer and payer specific policies and procedures. Responsible for reviewing the data in the claims processing system and compare with corresponding UB04 or CMS1500. Responsible for reviewing claims attachments when necessary to determine if services rendered was medically appropriate and benefit coverage criteria has been met. Responsible for reviewing adjudication software system’s claim and line items edits for determination of whether to pay claim/line item(s).

    As a Claims Examiner at UST HealthProof, this is your opportunity to
    • Be responsible for attending and successfully completing the trainings scheduled by the client and employer 
    • Be responsible for processing assigned claims based on client specified guidelines or as directed by team lead
    • Be responsible for meeting claims productivity targets of claims per hour or day as set by team lead
    • Collaborate with other team members on special projects as assigned by the team leads including process documentation, training, quality audit, assist with surge activity for client (s), or any other project as determined by the team lead
    • Develop Knowledge of physician practice and hospital coding, billing and medical terminology, CPT, HCPCS, ICD-9 and ICD-10, UB04, CMS 1500, authorization and other terms, terminology and concepts of healthcare
    • Develop some level of communication with client Claims managers to address issues, concerns and take preventive measures to avoid service quality issues
    • Be responsible for your attendance, time off and reporting shift timings etc. with the prime objective of meeting and exceeding customer deliverables
    • Participate in meetings and project activities outside of the primary location at locations determined by UST management team and team lead
    You bring:
    • High School degree required with one year of relevant professional experience in Healthcare claims operations for an insurance company or healthcare payor.
    • Willingness to learn new skills and succeed in a new career
    • Excellent verbal and written communication skills.
    • Proficiency with MS Office applications, especially Word and Excel.
    • Team collaborator
    • ICD-9 and ICD-10 coding is a plus, CPT and HCPCS coding, HIPAA is a plus
    • Strong work ethic with ability to multi-task is essential
    • High proficiency in using MS Excel and MS Office Suite
    • Good understanding and ability to analyze claims data and report, SLA, KPI, operations report and present findings in a structured way
    For this role, we value:
    • The ability to adapt quickly to a fast-paced environment, self-starter and quick learner
    • Excellent written and oral communication skills
    • Team Player and ability to collaborate

    Overall Experience level: 0-2 years of operation experience, any healthcare
     
    UST Global celebrates diversity and inclusion. We are an Equal Employment Opportunity employer. We welcome candidates to apply for employment from diverse backgrounds and believe your unique perspective adds to the richness of our company culture. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

     

  • Just Posted

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Claims Examiner Assistant
  • Universal Fire & Casualty Insurance Company
  • Dublin, OH FULL_TIME
  • Claims Examiner AssistantUniversal Shield Insurance Group (and its member companies – Universal Fire & Casualty Insurance Company (www.ufcic.com) and Shield Indemnity, Inc. (www.shieldindemnity.com) h...
  • 5 Days Ago

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Claims Assistant
  • Sedgwick Claims Management Services Inc.
  • Dublin, OH FULL_TIME
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flex...
  • 2 Months Ago

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Field Technician
  • Hancock Claims Consultants
  • Columbus, OH CONTRACTOR
  • CLIMB to New Heights… And live the_ American Dream. _Become part of something bigger by contracting with the nation’s top provider of roof and property inspection services working with insurance carri...
  • 2 Days Ago

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Service Center Representatives
  • Sedgwick Claims Management Services Inc.
  • Dublin, OH OTHER
  • The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option. Service Center Representatives IF YOU CARE, T...
  • Just Posted

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Examiner - Worthington
  • Regional Income Tax Agency
  • Worthington, OH FULL_TIME
  • JOB OPPORTUNITY We are looking for an individual who approaches work with initiative and a high level of integrity who also possess excellent critical thinking skills to join our growing team! Resumes...
  • 12 Days Ago

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0 Claims Examiner, Sr. jobs found in Columbus, OH area

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Commercial Lines Underwriter (hybrid/remote)
  • Grange Insurance
  • Columbus, OH
  • Summary: This position is responsible for achieving profitable underwriting results in support of growth and profit obje...
  • 3/19/2024 12:00:00 AM

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**REMOTE** Forensic Engineer/ Architect - SoCal
  • LVI Associates
  • Columbus, OH
  • Are you looking for a fully remote role with an opportunity for entrepreneurship? Join our skilled team handling diverse...
  • 3/18/2024 12:00:00 AM

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Senior AZ Workers' Compensation Claims Specialist | Remote
  • King's Insurance Staffing
  • Columbus, OH
  • Our client is expanding their presence in Arizona and seeking to add a Senior Workers Compensation Claims Specialist to ...
  • 3/17/2024 12:00:00 AM

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Mechanical Engineering Intern
  • Envista Forensics, LLC
  • Columbus, OH
  • Inspiring People - Impactful Experiences If there was one common theme to describe what our team members get from a care...
  • 3/17/2024 12:00:00 AM

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Internal Revenue Agent (Fed State Local Gvmt Spec - Examiner) 12 MONTH ROSTER AMENDED
  • Department Of The Treasury
  • Columbus, OH
  • Duties WHAT IS THE TAX EXEMPT & GOVERNMENT ENTITIES (TE/GE) DIVISION? A description of the business units can be found a...
  • 3/17/2024 12:00:00 AM

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Bodily Injury Claims Specialist
  • Auto-Owners Insurance
  • Columbus, OH
  • A career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial security by helpin...
  • 3/15/2024 12:00:00 AM

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Remote Claims Auditor II
  • National General Insurance
  • Columbus, OH
  • Job Description National General Insurance is recruiting for a Remote Claims Auditor . The ideal candidate should have a...
  • 3/15/2024 12:00:00 AM

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WC claims associate
  • Sedgwick
  • Dublin, OH
  • Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A c...
  • 3/15/2024 12:00:00 AM

The confluence of the Scioto and Olentangy rivers occurs just north-west of Downtown Columbus. Several smaller tributaries course through the Columbus metropolitan area, including Alum Creek, Big Walnut Creek, and Darby Creek. Columbus is considered to have relatively flat topography thanks to a large glacier that covered most of Ohio during the Wisconsin Ice Age. However, there are sizable differences in elevation through the area, with the high point of Franklin County being 1,132 ft (345 m) above sea level near New Albany, and the low point being 670 ft (200 m) where the Scioto River leaves...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner, Sr. jobs
$60,989 to $78,631
Columbus, Ohio area prices
were up 1.3% from a year ago

Claims Examiner, Sr. in Riverside, CA
Health Claims Examiners, or Health Information Technicians, enter data electronically to process transactions.
December 14, 2019
Claims Examiner, Sr. in Evansville, IN
If you’re in dire straits, we can advise you on steps to get the OWCP claims examiner to pay attention to your needs, such as contacting the Department of Labor’s district director, or the national director via mail.
February 12, 2020
Claims Examiner, Sr. in Springfield, IL
No, the examiner is only involved in performing the exam and providing the results to the claims processor.
January 13, 2020