Claims Examiner I
American Specialty Health Incorporated is looking for an experienced and proficient Claims Examiner to work in a production environment. This position enters data from HCFA-1500 Claim Forms into the Claims Processing System for all accounts. This position is responsible for the accurate review, input and adjudication of claims in accordance with regulations, ASH standards and contractual obligations of the organization.
The safety of our employees, both current and future, is ASH’s highest priority. At this time, most of our employees are working remotely due to the current COVID-19 pandemic. Candidates who are selected for this position will be trained remotely and must be able to work from home in a designated work area with company-provided technology equipment. Once ASH determines employees can return the office, candidates may be required to work in a local office. Limited visits to the office in person may be required. While onsite, social distancing and masks are required along with adherence to ASH’s Communicable Disease and Pandemic Policy.
- Reviews all incoming claims to verify necessary information.
- Maintains all required documentation of claims processed and claims on hand.
- Maintains production standard; processes an average of 31 claims per hour, with an accuracy rate of 98.5%.
- Provides backup for other examiners within the department and assists in training of new claims personnel.
- Attends organizational meetings as required, organizational policies and procedures and maintains confidentiality of all claims files, claims reports, and claims related issues.
- High school diploma required.
- Data entry experience with 10 key and word processing; minimum 10,000 key strokes per hour required.
- Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.
- Proficient in MS Office.
- Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.
- Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.
- Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.
- Ability to effectively organize, prioritize, multi-task and manage time.
- Demonstrated accuracy and productivity in a changing environment with constant interruptions.
- Demonstrated ability to analyze information, problems, issues, situations and procedures to develop effective solutions.
- Ability to exercise strict confidentiality in all matters.
Primarily sedentary, able to sit for long periods of time.
Ability to speak, see and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within the facility. Capable of using a telephone and computer keyboard. Ability to lift up to 10 lbs.
Usual office setting.
American Specialty Health is an Equal Opportunity/Affirmative Action Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex including sexual orientation and gender identity, national origin, disability, protected Veteran Status, or any other characteristic protected by applicable federal, state, or local law.
Please view Equal Employment Opportunity Posters provided by OFCCP here.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702.
ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company’s legal duty to furnish information.