Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives, and engage patients.
We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.
We are looking for a Claims Examiner. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization in Henderson, NV or remote, then you should consider joining our team.
Claims Examiner
Overall Purpose:
This position is responsible for analyzing, validating, and adjudicating medical insurance claims by verifying member eligibility, benefits, authorizations and approving payment or denial according to contractual agreements, policies, health plan, state, and federal laws, in a timely and accurate manner. The position requires a basic understanding of claims adjudication and payment policies. Ability to work in a training and learning capacity until fully competent to independently process claims for inpatient, outpatient and professional services for contracted and non-contracted providers. The position focuses on the health plan side of claims processing. It does not involve medical claims submission, revenue cycle from a provider prospective, worker's compensation, or auto insurance claims.
Education and Experience:
Knowledge, Skills and Abilities:
Essential Functions:
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor 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 contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
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