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View salary and benefits informationReviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. 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. Determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. Work is generally independent and collaborative in nature. Contributes to moderately comp more...
Reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Verifies coverage eligibility. Calculates settlement amounts according to guidelines. Processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. Works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. Typically requires 3-5 years of related experience. more...
Audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Selects claims through random processes and/or other criteria. Makes recommendations to improve quality, workflow processes, policies and procedures. Typically requires an associate degree. Typically reports to a supervisor or a manager. A specialist on complex technical and business matters. Work is highly independent. May provide a leadership role for the work group through knowledge in the area of specialization. Typically requires 7+ years of related experience. more...
Receives and inputs new healthcare claims, processes payments, conducts billing research, and responds to telephone inquires. Evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Produces routine and ad hoc reports. Requires a high school diploma. Typically reports to a supervisor. Works independently within established procedures associated with the specific job function. Has gained proficiency in multiple competencies relevant to the job. Typically requires 3-5 years of related experience. more...
The Insurance Claims Examiner III examines and authorizes insurance claims investigated by insurance adjusters. Reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Being an Insurance Claims Examiner III communicates with agents, claimants, and policy holders. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. In addition, Insurance Claims Examiner III determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports t more...
The Claims Payment Clerk III inputs claim information into system for processing. Reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Being a Claims Payment Clerk III calculates settlement amounts according to guidelines. Verifies coverage eligibility. In addition, Claims Payment Clerk III processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. Being a Claims Payment Clerk III works independently within established procedures associated with the specific job more...
The Medical Claims Operations Clerk III evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Receives and inputs new healthcare claims, processes payments, conducts billing research, and responds to telephone inquires. Being a Medical Claims Operations Clerk III requires a high school diploma. Produces routine and ad hoc reports. In addition, Medical Claims Operations Clerk III typically reports to a supervisor. Being a Medical Claims Operations Clerk III works independently within established procedures associated wi more...
The Claims Quality and Compliance Auditor III selects claims through random processes and/or other criteria. Audits claims for coding accuracy, benefit payment, contract interpretation, and compliance with policies and procedures. Being a Claims Quality and Compliance Auditor III typically requires an associate's degree. Makes recommendations to improve quality, workflow processes, policies and procedures. In addition, Claims Quality and Compliance Auditor III typically reports to a supervisor or a manager. Claims Quality and Compliance Auditor III is a specialist on complex technical and busi more...
Supervises the administration of health insurance claims, payment processing, billing research, and responding to inquiries. Ensures the accurate and timely disposition of claims and resolves matters according to coverage amounts and company procedures. Provides guidance to staff on more complex or high-value claims. Reviews and resolves escalated issues. Requires a high school diploma. Typically reports to a manager. Supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes more...
Supervises and coordinates daily activities of claims quality auditors. Provides assistance in developing claims audit policies and procedures. Solves day-to-day problems and monitors the results of daily staff activities, reports critical issues and problems to the management. Typically requires a bachelor's degree. Typically reports to a manager. Supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Makes day-to-day decisions within or for a group/small department. Has some authority more...
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