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3 Claims Examiner jobs match your search criteria.

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Job Description: Claims Administrator Claims Administrator Location: Windsor, CT Salary: $12-$14 per hour Experience: 0.0 year(s) Job Type: Temporary / Consulting Job ID: U1007930       About the Opportunity A widely recognized health insurance company located in Windsor, CT is actively seeking a self-motivated and diligent individual for a promising opportunity on their staff as a Claims Administrator. In this role, the Claims Administrator will be responsible for review of new LTD, Life, and other disability claim documents, as well as preparing new LTD, Life, and other disability claims. Company Description Health Insurance Company Job Description The Claims Administrator will: Assign new claims to the appropriate claims examiner based on pre-determined criteria Monitor and report new claim inventory levels Respond to all e-mail and phone inquiries within 24 hours Handle various administrative functions Establish excellent relationship with claim organization Maintain high levels of customer service with internal and external customers Required Skills Proficient with Windows and Microsoft applications Ability to work and solve problems independently Strong interpersonal skills Highly organized Ability to work independently or part of a team Good communication skills Proven time management skills Desired Skills Bachelor's Degree or equivalent work experience

Job Description: Complaints and Appeals Associate Complaints and Appeals Associate Location: Wall, NJ Salary:  Experience: 5.0 year(s) Job Type: Temporary / Consulting Job ID: U1011139       About the Opportunity A respected healthcare facility located in Wall, NJ is actively seeking an organized and self-motivated individual for a promising opportunity on their staff as a Complaints and Appeals Associate. In this role, the Complaints and Appeals Associate manages resolution of complaints and/or appeals that have been escalated to executives or regulatory entities within prescribed timeframes as mandated by the regulatory entity and per designated quality standards. Apply today! Company Description Healthcare Facility Job Description The Complaints and Appeals Associate: Assesses cause(s) of complaint/appeal, conducts thorough research of issue(s), and determines required course of action and final disposition Interacts with relevant parties to facilitate timely and accurate complaint/appeal resolution Authorizes administrative exceptions, which may involve claim adjustment Contacts relevant party(ies) to acknowledge receipt of the complaint/appeal and uses probing techniques Reviews business team representative/vendor representative telephone calls with customers to verify accuracy of information related to complaint/appeal Develops customized, timely, accurate, detailed correspondence, for delivery to relevant party(ies), detailing case and final resolution Responds to regulatory entity or members/providers Partners with Legal Department to review and finalize appeal determinations Prepares materials for and may attend case study meetings facilitated by designated internal or external parties Required Skills College degree in Journalism, Communications, or related field, or equivalent in experience 5 years of business experience, which must include 2+ years of correspondence and/or telephone customer service experience screening, investigating and examining inquiries Experience in claims processing necessary Ability to navigate the various claims and service operations systems Knowledge of Microsoft Office Suite Ability to perform basic arithmetical calculations Ability to analyze information and to understand and apply rules and procedures Ability to compose business letters   Desired Skills Healthcare industry experience Knowledge of insurance claim and membership systems Knowledge of medical terminology, COB, Medicare procedures Knowledge of UCSW Knowledge of Claims Policy guidelines

Job Description: Complaints and Appeals Associate Complaints and Appeals Associate Location: Wall, NJ Salary:  Experience: 5. year(s) Job Type: Temporary / Consulting Job ID: U1006774       About the Opportunity A healthcare organization in New Jersey is looking to fill an immediate need with the addition of a new Complaints and Appeals Associate to their growing staff. In this role, the Complaints and Appeals Associate will be responsible for managing the resolution of complaints and/or appeals that have been escalated to the organization's Executives or regulatory entities within prescribed timeframes as mandated by the regulatory entity and per designated quality standards. This is a great opportunity for a detail oriented and diligent professional to gain valuable work experience and further their career with an established organization. Apply today! Company Description Healthcare Organization Job Description The Complaints and Appeals Associate: Assesses cause(s) of complaint/appeal, conducts thorough research of issue(s), determines required course of action and final disposition. Interacts with relevant parties to facilitate timely and accurate complaint/appeal resolution Authorizes administrative exceptions which may involve claim adjustment resulting in payments at higher threshold levels so as to bring closure to the complaint/appeal Contacts relevant party(ies) to acknowledge receipt of the complaint/appeal and uses probing techniques to clarify open issues, obtain additional relevant information and/or secure records necessary to complete investigation and bring issue to final resolution Review business team representative/vendor representative telephone calls with customers to verify accuracy of information related to complaint / appeal Develops customized, timely, accurate, detailed correspondence, for delivery to relevant party(ies), detailing case and final resolution Responds to regulatory entity or members/providers, both verbally and in writing, regarding issue details and final determination made by the organization to close the complaint / appeal Partners with Legal Department to review and finalize appeal determinations Prepares materials for and attends case study meetings facilitated by designated internal or external parties Required Skills 5+ years of Business experience, including 2+ years of Correspondence and/or Telephone Customer Service experience screening, investigating and examining inquiries College Degree in Journalism, Communications, or related field Experience in Claims Processing Microsoft Office/Suite proficient Solid research, investigative, analytical, decision making and problem solving skills Exceptional phone etiquette Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Healthcare industry experience Knowledge of Insurance Claim and Membership Systems Knowledge of Medical terminology, COB, and Medicare procedures Knowledge of UCSW Knowledge of Claims Policy guidelines

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The main task of medical claims examiner jobs is to confirm the validity of health insurance claims. Insurance companies often have claims examiner positions to protect the company from fraud while also ensuring that customers get the medical care they need. The typical medical claims examiner can expect to deal with a lot of paperwork, because he needs to look at the details of each claim carefully to make sure the treatment received is appropriate for the medical issue reported. If there is any doubt, then medical claims examiners may have to arrange interviews with medical specialists so they can clear up any confusion. If fraud is suspected, then claims examiners may need to research further with the help of special investigators.

ADVANCE lists the best medical claims examiner jobs in top facilities and companies across the nation.  Use our resume service to create and store your resume, apply instantly to jobs, get email alerts when opportunities match your interests and much more, right here.  Our site offers you access to the easiest and most targeted claims examiner positions search available.