****TO APPLY FOR THIS POSITION, PLEASE CLICK ON THE LINK BELOW:
http://www.cowcreek-nsn.gov/employment/

Claims Examiner II
Job Code: 1135
Department: Benefits Administration
Location: Roseburg, OR
Minimum Hourly: $25.71

POSITION PURPOSE:
This position is responsible for claims production and overseeing the accurate and timely adjudication of claims in accordance with plan benefits and maintain established production and quality standards.

ESSENTIAL FUNCTIONS:
• Claim auditing to ensure accuracy of claim processing
• Train level I claim examiners
• Customer service support
• Maintain resource materials with up-to-date information for claims and customer service staff
• Adjudicate electronic and manual claims for all lines of coverage (Medical, Dental, Vision) based on coverage benefits, coding guidelines, medical review determination, prior-authorization, and benefit limitations.
• Advanced knowledge CPT, HCPCS, ICD10, Revenue codes, CDT, etc.
• Ability to research and identify third party liability, coordination of benefits (COB) cases and apply benefits accordingly as well as updating of eligibility records.
• Ability to understand and manually calculate all types of claims pricing (Medicare, Medicaid)
• Satisfy required quantity/quality claims processing requirements.
• Ability to effectively communicate with members, providers, and other team members.
• Maintain confidentiality and project a professional business presence and appearance.
• Performs other related duties as assigned.

QUALIFICATIONS:
• 3-5 years medical claims processing experience
• Knowledge of Medical Terminology and health benefits required.
• Good analytical, problem solving and decision-making skills.
• Excellent verbal and written communication skills including active listening.
• Proficient computer skills with ability to learn new software.
• Organized with attention to detail.
• Ability to multi-task and work independently with minimal supervision.
• High school diploma or equivalent.

****TO APPLY FOR THIS POSITION, PLEASE CLICK ON THE LINK BELOW:
http://www.cowcreek-nsn.gov/employment/

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Claims Examiner II