Claims Examiner
Rose international
New York, New York
certificate
medical
education
w2
claims handling
insurance
delivering
customer experience
calls
providers
attorneys
resolving
data
November 23, 2022
Rose international
New York, New York
- Only U.S. Citizens and those authorized to work in the U.S. may be considered as W2 candidates.
- Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a clients business needs and requirements.
- Job Title: Claims Examiner
- Candidate must have 5+yrs California examining experience.
- if candidate is from other States, MUST have recent California claims handling experience and MUST hold the California Examiner Designation certificate as well as the Self Insurance Certificate
- PRIMARY PURPOSE: To provide high quality service to both internal and external customers, delivering an easy and efficient customer experience for routine lost time.
- ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Processes incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving their claims related questions and issues in accordance with designed guidelines and policies.
- Communicates claims status and current claim activity with client and appropriate medical contact; responds to inquiries about jurisdiction- and claim-specific issues.
- Enters data into claims system(s) and ensures claim files are properly documented and claims coding is correct.
- Coordinates claimant address updates or changes with internal departments.
- Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations.
- ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organizations quality program(s).
- Education & Licensing
- High school diploma or GED required.
- Associates degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Two (2) years of administrative and/or customer service experience or equivalent combination of education and experience required.
- Skills & Knowledge
- Excellent oral and written communication skills PC literate, including Microsoft Office products Strong investigation and organizational skills
- Good interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
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