Claims Examiner I

American Specialty Health Incorporated (ASH) is seeking an Examiner I to join our Claims department. The primary purpose of this position is to verify claim information lifted from the CMS 1500 form by Optical Character Recognition and enter data from CMS 1500 Claim Forms into the Claims Processing System, and to process claim edits from electronic claims. This position is responsible for the accurate review, input and adjudication of claims in accordance with regulations, ASH standards and contractual obligations of the organization. Remote Worker Guidelines

• Remote Worker Guidelines: This position will be trained remotely and must be able to work from home (WFH) in a designated work area with company-provided technology equipment. This WFH position requires you have a stable connection to your Internet Service Provider with the ability to participate by video in online meetings over a reliable and consistent network (minimum 50 Mbps download and 50 Mbps upload speed.)

Responsibilities

• Processes claims accurately and efficiently.

  • Reviews all incoming claims to verify necessary information.

  • Determines that correct member and provider records are chosen and utilized to process claims.

  • Enters claims data and information into the computerized Claims Processing System.

  • Maintains all required documentation of claims processed and claims on hand.

  • Adjudicates claims in accordance with departmental policies, procedures, state and accreditation standards and other applicable rules.

  • Maintains production standards; for direct data entry claims this includes processing an average of 31 claims per hour, with an accuracy rate of 98.5% over each pay period.

  • Verifies data of scanned paper claims at stated standards.

  • Provides backup for other examiners within the department.

  • Promotes a spirit of cooperation and understanding among all personnel.

  • Attends organizational meetings as required.

  • Adheres to organizational policies and procedures.

  • Maintains confidentiality of all claim files, claims reports, and claims related issues.

• Performs other duties as assigned.

• Complies with all policies and standards.

Qualifications

• High School Diploma or GED certificate required.

• 6 months data entry experience with 10 key and word processing; minimum 10,000 keystrokes per hour required.

• Experience processing medical claims and knowledge of medical billing terminology and coding strongly preferred.

• Proficient in MS Office.

• Ability to work and maintain production in a work-from-home (WFH) environment.

• Demonstrated ability to show self-discipline to meet production goals.

Core Competencies

• Demonstrated ability to interact in a positive, respectful manner and establish and maintain cooperative working relationships.

• Ability to display excellent customer service to meet the needs and expectations of both internal and external customers.

• Excellent listening and interpersonal communication skills to identify critical core competencies based on success factors and organizational environment.

• Ability to effectively organize, prioritize, multi-task and manage time.

• Demonstrated accuracy and productivity in a changing environment with constant interruptions.

• Demonstrated ability to analyze information, problems, issues, situations, and procedures to develop effective solutions.

• Ability to exercise strict confidentiality in all matters.

Mobility

• Primarily sedentary, able to sit for long periods of time.

Physical Requirements

• Ability to see, speak, and hear other personnel and/or objects. Ability to communicate both in verbal and written form. Ability to travel within and around the facility or Work from Home (WFH) environment. Capable of using a telephone, computer keyboard, and mouse. Ability to lift up to 10 lbs.

Environmental Conditions

• Work-from-home (WFH) environment.

American Specialty Health is an Equal Opportunity/Affirmative Action Employer.

All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth, related medical conditions, breastfeeding, and reproductive health decision-making), gender, gender identity, gender expression, race, color, religion (including religious dress and grooming practices), creed, national origin, citizenship, ancestry, physical or mental disability, legally-protected medical condition, marital status, age, sexual orientation, genetic information, military or veteran status, political affiliation, or any other basis protected by applicable local, federal or state law. Please view Equal Employment Opportunity Posters provided by OFCCP here. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact our Human Resources Department at (800) 848-3555 x6702. ASH will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the Company's legal duty to furnish information.

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