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)
9 - 12 Years Healthcare experience must
9 - 12 years of experience in US Healthcare Payor operation.
Including, 7-10 years of experience in managing teams,
Strong operational & people management skill with experience of handling minimum of 100 employees
Working & Team handling Experience in claim adjudication/ Payment integrity/Enrollment
Excellent communication & interpersonal skills; team oriented and strong consensus building
Advanced knowledge of MS Word, MS Excel and Data management
Ability to operate in a rapidly changing environment with a sense of urgency, and to develop and deploy changes positively
Demonstrated analysis and problem solving abilities
Strong organizational and time management skills
The ability to multitask and self-manage workday is crucial.
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0 Claims Examiner, Sr. jobs found in Medford, OR area