Medical Claims Examiner

The Claims Examiner position responsible for processing medical, dental and vision claims. This position is looking for someone to work in the Canfield Ohio office. Upon completion of training and satisfactory meeting quality and production goals. You will be eligible to participate in our corporate hybrid policy that allows you to work part of the week at home and part of the week in the office.

• Review and process medical claims according to Plan guidelines within established turnaround time frames
• Interpret medical plan to assure system is coded correctly
• Review claims for legitimacy and accuracy
• Meet production and quality standards set for examiners
• Work Customer Service inquiries related to claim questions
• Review correspondence submitted by members and providers and adjust all related claims if the additional documentation submitted warrants adjustment
• Other duties as assigned

• High School/GED required
• Demonstrate skills in problem solving and benefit plan interpretation
• Knowledge of CPT codes, ICD9/ICD10 codes and/or medical terminology is a plus
• Ability to work independently
• PC proficiency
• Average typing ability