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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

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