Claims Examiner

Technical Skills:

- Generate pre-check register and authorization form for clients.

- Verify approvals have been received.

- Modify pre-check based on approvals received, ensuring the batch ties to the client approval.

- Generate export file from claims system for check printing.

- Obtain secondary approval from clients in situations with interest payments, prior to releasing export file for check printing.

- Import check register file into claims system.

- Coordinate voided checks with the claims department.

Additional Functions:

- Assists with special projects, as requested.

- Communicates clearly and concisely, with sensitivity to the needs of others.

- Maintains the confidentiality of all company procedures, results, and information about participants, clients, providers and employees.

- Maintains courteous, helpful and professional behavior on the job.

- Establishes and maintains effective working relationships with co-workers.

- Ensures customer satisfaction by understanding and applying the Customer Service Policy, Procedure and Standards.

- Follows all Policies and Procedures and HIPAA regulations.

- Maintains knowledge and understanding of current Medicare regulations related to PACE Health Plan Management.

- Maintains a safe working environment.

- Maintains knowledge and understanding of current Medicare claims processing guidelines.

- Attends continuing education seminars as requested.