Claims Examiner III

DOCTORS HEALTHCARE PLANS, INC.Coral Gables, FL

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Overview

Schedule

Full-time

Career level

Senior-level

Job Description

Position Purpose:The Claims Examiner III ensures that claims are processed according to department standards and assists the Claims manager in maintaining the workflow and processes, in order to achieve set goals.

Key Responsibilities:

Review and release professional and institutional claims
Process Member Reimbursement claims
Coordinates with the Assistant Director the weekly/monthly workflow issues and set goals for the department
Assists the Assistant Director on generating reports to track productivity and pending items
Collaborate in the application of policies and procedures of the department
Collaborate with the Assistant Director to ensure the team is meeting production and quality metrics
Communicate effectible to the department staff the strategy to improve performance and meet stablished goals
Maintain a positive environment that support staff well-being and foster an atmosphere that builds teamwork
Ensure that the team utilizes the system capabilities to its maximum potential
Performs other duties as necessary

Qualifications:

High School Diploma or GED
3+ years as Medical Claims Examiner
Experience in contract interpretation
Knowledge of CMS guidelines and regulations
Ability to work Windows and other computer applications
Ability to work well with others

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted. Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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