Claims Examiner I
On-site · San Antonio, Texas, United States
Job Summary
Day-to-day processing of claims for accounts including medical, dental, vision, and mental health claims; claims processing and adjudication; claims research; reviews to verify medical necessities and coverage under policy guidelines; investigate and administer overpayments; facilitate claims investigations and settlements; respond to Department of Insurance complaints; handle claims appeals and verify benefits; requires 2+ years of claims experience, CPT and ICD-9 coding knowledge, HIPAA/ COBRA familiarity, and strong communication skills. In-office role based in San Antonio, TX with training start dates and potential flexible options after training; schedule 8:00am–4:30pm CST.
Required Qualifications
- High school diploma or GED
- 2+ years related work experience
- Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry
- Knowledge of CPT and ICD-9 coding
- Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits
- Proven judgment and decision-making skills; ability to analyze
- Ability to learn quickly and multitask
- Proficiency in Microsoft Windows, Word, and Excel; experience with medical CPT coding
- Review of multiple surgical procedures and establishment of reasonable and customary fees
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