Claims Examiner jobs in North Las Vegas, NV

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)

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Claims Examiner
  • P3 Health Partners
  • Henderson, NV FULL_TIME
  • 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:

    • High school diploma or GED
    • Requires a minimum of 4 years of experience in claims adjudication, in a managed care environment, specializing but not limited to professional claims adjudication and payment
    • 2 years of Medicare Advantage (HMO) claims adjudication experience preferred
    • Ez-Cap experience preferred

    Knowledge, Skills and Abilities:

    • Must have a strong understanding of any local, state and federal rules regarding the adjudication of medical benefits.
    • Personal computer with main frame emulation, claims management software, word processing and management software, 10-key adding machine, Imaging retrieval software, fax machine, copy machine, basic office aids.
    • Strong knowledge of CPT, ICD-10 and CMS Guidelines for processing professional claims.
    • Working knowledge of HMO operations, claims delegation compliance and contract interpretation.
    • Ability to adhere to all departmental policies and processing guidelines
    • Ability to deal with complex claim issues
    • Ability to handle multiple projects and able to prioritize workload
    • Demonstrated ability to work with and preserve confidential information
    • Strong interpersonal, organizational, and critical thinking skills
    • Ability to work without close supervision in a self-directed manner and also as a team member
    • Ability to effectively communicate with internal and external associates
    • Excellent communication and written skills
    • A self-starter, passionate with a positive attitude

    Essential Functions:

    • Adjudicates medical claims according to provider contracts, processing guidelines and in compliance with all state, federal and health plan laws & regulations, and CMS Guidelines maintaining a statistical and financial accuracy of 99%.
    • Verifies patient eligibility, benefits and authorizations
    • Prioritizes assigned claims according to regulatory timelines
    • Requests additional information for incomplete or unclean claims; follows up as necessary
    • Notifies Management immediately when claims cannot be processed within the processing timelines
    • Documents medical claims actions by maintaining reports, logs, and records
    • Maintains productivity and quality standards as defined by the Management
    • Maintains quality customer services by following customer service practices; responding to customer inquiries
    • Complies with company’s attendance and punctuality standards
    • Promotes teamwork and cooperation with other staff members and management
    • Ability to repeatedly produce high quality results
    • Responsible for quality and continuous improvement within the job scope.
    • Ability to function in a fast-paced environment while maintaining focus and control of workload
    • Contributes to and supports the corporation’s quality initiatives by planning, communicating, and encouraging team and individual contributions toward the corporation’s quality improvement efforts
    • Other duties as assigned


    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)

  • 1 Day Ago

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Claims Examiner
  • P3 Health Partners Brand
  • Henderson, NV FULL_TIME
  • 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 missi...
  • 2 Days Ago

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Claims Examiner 2 (POPA)
  • Zenith American
  • Las Vegas, NV OTHER
  • JOB TITLE: Claims Examiner 2 DEPARTMENT: Claims (Las Vegas) REPORTS TO: Brooke Reid JOB DUTIES: Investigates, analyzes, and determines extent of plan's liability concerning medical, dental, vision, ph...
  • 8 Days Ago

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NV - Las Vegas - 1099 Property Claims Adjuster
  • Copper Claims Services, Inc.
  • Las Vegas, NV FULL_TIME
  • 1099 Property Claims Adjuster Copper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA with offices in California, Arizona, Oregon, Nevada, Washington, Utah,...
  • 1 Month Ago

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MEDICAL EXAMINER
  • Clark County
  • Las Vegas, NV FULL_TIME
  • The Clark County Office of the Coroner/Medical Examiner is seeking to fill the Medical Examiner/Forensic Pathologist position. This office serves Clark County, Nevada, which includes Las Vegas and sur...
  • Just Posted

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Veteran's Disability Examiner
  • LibertyExams
  • Henderson, NV FULL_TIME,CONTRACTOR
  • ****Unique, low-stress opportunity to help our Veterans**** Full-time position available! Are you thinking about a change from the daily grind of clinical medicine? If so, disability medicine may be r...
  • 23 Days Ago

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0 Claims Examiner jobs found in North Las Vegas, NV area

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Insurance Agent
  • Bankers Life
  • Las Vegas, NV
  • Bankers Life® seeks professionals for a dynamic hybrid remote work environment. Start your insurance agent career and ea...
  • 3/28/2024 12:00:00 AM

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Life Insurance Agent
  • The Alicea Insurance Agency
  • North Las Vegas, NV
  • Organization Description: The Alicea Insurance Agency is an insurance and financial services agency. Our company was fou...
  • 3/28/2024 12:00:00 AM

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Insurance Agent
  • Smog Plus LLC
  • Las Vegas, NV
  • Job Description Job Description We are seeking an experienced Insurance Agent to join our team! You will be responsible ...
  • 3/28/2024 12:00:00 AM

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Life Insurance Agent
  • Frontline Insurance
  • Las Vegas, NV
  • Job Description Job Description This is an outbound sales position where you would be reaching out to leads that request...
  • 3/28/2024 12:00:00 AM

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Insurance Agent
  • Carothers Insurance
  • Las Vegas, NV
  • We offer experience, community, exclusive contracts, endless product offerings, training, and business support so you ca...
  • 3/27/2024 12:00:00 AM

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Insurance Agent
  • Aflac
  • Las Vegas, NV
  • Full Job Description This is a truly rewarding Business-to-Business position that offers one of the strongest compensati...
  • 3/27/2024 12:00:00 AM

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Licensed Insurance Agent
  • Colonial Life
  • Las Vegas, NV
  • Our local agency is growing, and we are looking for the right candidate to help train, mentor, and develop a successful ...
  • 3/27/2024 12:00:00 AM

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INSURANCE AGENT - REMOTE
  • Roethlisberger Group
  • Las Vegas, NV
  • We're seeking licensed Life, Health and Accident agents to join our rapidly growing company. Qualities we're looking for...
  • 3/26/2024 12:00:00 AM

North Las Vegas is a city in Clark County, Nevada, United States, in the Las Vegas Valley. As of the 2010 census it had a population of 216,961, with an estimated population of 249,180 in 2017. The city was incorporated on May 16, 1946. It is in the Las Vegas–Paradise, NV MSA and is the fourth largest city in the state of Nevada. Located in the southwestern United States in the Mojave Desert, North Las Vegas sits north and east of Las Vegas. According to the United States Census Bureau, North Las Vegas has a total area of 101.4 square miles (262.6 km2), of which 0.04 square miles (0.1 km2), o...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$48,521 to $64,345
North Las Vegas, Nevada area prices
were up 2.5% from a year ago