Claims Examiner
BASIC FUNCTION:
- Research and make benefit determinations for the processing or medical and hospital claims according to contractual and processing guidelines.
- Identify and communicate claims processing, procedural and training issues to Supervisor.
- Maintain production and quality in accordance with the departmental standards.
- Organize and handle individual workload to ensure that all new work and 'pend' claims are processed on a "first in/first out" basis.
- Exhibit professionalism and perform in a manner that supports the company's emphasis on customer service and operational excellence.
