Claims Examiner, Sr. jobs in Oregon

Position: Claims Examiner Trainee

Attention certified medical coders, medical billing specialists, medical front office staff: Entry level temporary position with established medical claims payer. Great opportunity to get your foot in the door. Potential to convert to permanent, long-term position with career growth opportunity.

Job Purpose

Under limited supervision of the Supervisor this position will apply techniques to process routine and complex claims, analyze expenditures and make recommendations for third-party liability claims.

Job Duties:

• Work with trainer and/or assigned co-worker to learn and perform review of plan documents and procedures to apply plan provisions, limitations and exclusions when making benefit determinations.
• Learn to request information to complete or review claims using standard procedures and letters, and asks questions as needed.
• Must demonstrate ability to learn and grow with continuous improvement and ability to increase average daily claim production while maintaining accuracy and quality.
• Performs computations and processes claims independently up to the dollar threshold set by the trainer not to exceed the job classification maximum of $1,500.00.
• Learns to perform duties and prepare to become a Claims Examiner by meeting training objectives and expected production metrics.
• Communicates efficiently by telephone, in writing or in person with all personnel, members, providers, external vendors or others regarding claim benefit questions or information.
• Communicates with the Quality Assurance Supervisor in conjunction with their trainer as necessary to request and receive data on pending claims.
• Learns to apply procedures to third-party liability claim claims.
• Exercises professional judgment on daily tasks and seeks approval from supervisor or trainer when faced with new or unfamiliar tasks.
• Maintain a 10 business-day turnaround time on assigned claim responsibilities.
• Maintain and update a pending file with follow-ups on correspondence as required.
• Ability to meet production and quality goals on a consistent basis as outlined within training.
• Routes claims requiring review to the assigned Claim Adjuster Senior II.
• Demonstrates knowledge of assigned duties as well as the legacy and the recently migrated claims processing system.
• Perform other duties as assigned.

Minimum qualifications:

• Certified medical coder, or 6 months minimum experience in medical coding, billing, or front office.
• Working knowledge of basic office equipment with minimum keyboard speed of 35 words per minute.
• Positive interpersonal communications with internal and external clients and vendors.
• Demonstrated ability to keep calm and positive within all communications.
• Proven ability to accurately and timely review and edit documents.
• Utilize computer, phone systems and reference materials to be able to effectively perform the essential functions of the position.
• Previous experience utilizing Microsoft office software
• High school diploma or G.E.D

Preferred qualifications

• 2 years of college experience in a related field- do not have to have an associate degree

Job Type: Temporary

Pay: $17.36 - $22.58 per hour

Expected hours: 37.5 per week

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• Monday to Friday

Travel requirement:

• No travel

Work setting:

• In-person
• Office

Ability to Relocate:

• Gladstone, OR 97027: Relocate before starting work (Required)

Work Location: In person