Humera - Administrative and Professional Staffing

Claims Examiner

Location
Minneapolis, MN, United States
Salary
$17.00 /hr - $17.00 /hr
Posted
Jul 08, 2017
Closes
Jul 10, 2017
Job Type
Employee
Employment Status
Full Time
Humera has positions available for Claims Examiners with our client in NE Minneapolis, a company providing health coverage and services to members in Minnesota and western Wisconsin.


Duties:
This position will research, resolve, examine and process paper and/or electronic claims submitted for payment. Interact with internal customers to obtain needed information for claim processing. Process claims reviewing Policies and Procedures, Coordination of Benefits, and applying appropriate plan provisions, CMS Regulations and DHS guidelines for payment determination.

  • Ensure accurate and timely processing of claims in accordance with DHS and CMS Regulations and Claims Department Work Instructions
  • Maintain department production and quality standards
  • Work pending file as directed by Claims Leadership. Follow up on pending claims according to Department Service Level Agreements
  • Interaction with internal customers to obtain needed information to process claims and to provide detailed claim information
  • Other duties as assigned

Requirements:
    Education:
  • High School diploma or relevant experience
  • Required Experience:
  • Six months experience with medical claims knowledge. Knowledge of ICD10 and CPT coding and medical terminology experience
  • Previous insurance claims processing
  • Preferred Experience:
  • Experience in a healthcare organization, working knowledge of Medicaid, Medical Assistance, Minnesota Care, Medicare and Commercial insurance is helpful
  • Amisys Claims System and MACESS EXP experience a plus


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