Claims Examiner - Hybrid

Company: AGIA
Location: Scottsdale
Posted on: May 16, 2022

Job Description:

The Claims Examiner is responsible for analyzing and adjudicating claims for group cancer and hospital indemnity plans in a timely and accurate manner and in strict accordance with defined carrier, state and federal requirements to ensure an excellent customer experience.Essential Job Functions

• Research submitted claims and records regarding eligibility and compliance with the provisions of the Certificate of Coverage to ensure accurate application of coverage benefits.
• Process low to medium complexity claims to ensure timely and accurate response to claimants in strict accordance with carrier, state, federal and internal compliance requirements.
• Generate concisely written correspondence to members, insureds and providers to request required information in a timely and accurate manner and follow-up as needed.
• Monitor and review pended claims to ensure that final claim determination and follow-up are performed in accordance with carrier, state and federal requirements.
• Support the Member Benefits Service Department with customer inquiries.Qualifications
  • High school degree or equivalent.
  • One year claims analysis and adjudication experience with health claims preferred.
  • Knowledge of CPT codes, RVS codes and ICD9/10 coding and medical terminology.
  • Basic proficiency in MS Office.
  • Strong attention to detail.
  • Strong alpha numeric and ten-key typing skills.
  • Ability to work in a fast paced and changing environment.
  • Excellent customer service skills.
  • Good verbal, written and interpersonal skills.
  • Good deductive reasoning, problem solving and analysis skills.Work Environment:
    • No weekend work; Monday-Friday only
    • A relaxed work environment with casual dress everyday
    • Covered parking year around
    • Located by a variety of restaurants, shopping venues and public transportationWhy You Should Apply:
      • AGIA Affinity Services has over 60 years of unparalleled success
      • We offer competitive pay with a 401K company match
      • We offer a competitive and intuitive benefit package, first of month after date of hire
      • Paid vacation
      • 13 Paid Holidays
      • We are a group of individuals who work, volunteer and hang out together
      • We give back to our surrounding communities through various channels
      • Remote, following completion of in-person training

Keywords: AGIA, Scottsdale , Claims Examiner - Hybrid, Other , Scottsdale, Arizona