Claims Examiner, Sr. jobs in Ohio
Claims Examiner, Sr. reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner, Sr. 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, Sr. determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner, Sr. occasionally directed in several aspects of the work. Gaining exposure to some of the complex tasks within the job function. To be a Claims Examiner, Sr. typically requires 2 -4 years of related experience. (Copyright 2024 Salary.com)
Recently Added Claims Examiner, Sr. jobs
Claims Examiner
- Roundstone
-
Lakewood, OH
FULL_TIME
-
Bywater Claims ExaminerFounded in 2003, Roundstone is not your typical insurance company. We’re on a mission to help employers save on healthcare benefits so they can put those savings towards bettering their businesses and taking care of their employeesRole DescriptionAs a Bywater Claims Examiner you will review medical, dental, and vision claims to determine appropriate payment. This role requires the ability to accurately process claims in a timely manner and manage service requests. Bywater Claim Examiners are subject matter experts and are often asked to explain claim processing or review previously paid claims for accuracy. To be successful in this role, one must be flexible, able to see the big picture while paying attention to small details, and able to manage their time independently.Key Duties & Responsibilities:
- Ability to read, understand, and communicate medical benefits according to SPD language;
- Prompt and timely processing of claims accurately according to established expectations (150 claims per day);
- Process claims in accordance with benefit contracts, plan policies, and production/quality requirements;
- Prior to claim adjudication, establish proof of loss by reviewing and understanding medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting an investigation of questionable claims;
- Request and follow-up on additional information as needed for incomplete claims, including but not limited to COB, accident investigations, eligibility, etc.;
- Familiar with and understands various fee schedules;
- May include but are not limited to: processing claims, claim system testing, over/under payments and special projects.
Desired Qualifications:- Knowledge of TPA administrative services, policies, procedures and systems, testing of plan setup;
- 3 years experience processing Medical, Dental, Vision claims applying appropriate benefits;
- Certified in Medical Terminology I, II and ICD9/10 knowledge;
- Excellent verbal, communication, and written skills with strong organizational and research skills;
- Proficiency in Microsoft Office (Word, Excel and Access);
- Must be detail-oriented, have ability to work well under pressure, and handle multiple tasks with deadlines;
- Bilingual (English/Spanish) skills a plus.
Better Benefits:We’re leaders in our industry, so naturally, we look out for our employees’ best interests with a robust benefits package. Roundstone employees are eligible for:- Medical, dental and vision benefits
- Annual bonus
- Dependent care 100% match up to max allowable
- PTO beginning on Day 1
- Tuition reimbursement
- Health work/life balance
- Hybrid office schedule
- 401(k) plan with company match
- Employee Assistance Program
- On-site gym with personal trainer access
- Life insurance and short term disability insurance
More About RoundstoneHeadquartered in Lakewood, Ohio, Roundstone is regularly recognized as a Northeast Ohio Top Workplace by the Plain Dealer and cleveland.com. We are especially proud to be recognized as a Top Workplace since this honor is determined by anonymous feedback from our own employees. Roundstone employees enjoy a supportive workplace where they are engaged, valued and regularly recognized for their hard work at monthly company meetings. Roundstone’s core values are evident every day and are shared with the community through the sponsorship of community events and outreach.Our Core Values- Live well: Be healthier and bring positive energy to all you do.
- Work smarter: Get things done, better.
- Own it: Accountability is your middle name. Be on time, do what you say, and finish what you start.
- Be intellectually curious: Always be learning. See opportunity everywhere and have a drive to know.
Culture and fit are integral to success and in an effort to achieve a better match both from a candidate's perspective and our organization, please take a minute, click on the link and take the really brief survey:https://go.apply.ci/p/XoefKbRCMZnLDon't meet every single requirement? Studies have shown that women and people of color are less likely to apply to jobs unless they meet every single qualification. At Roundstone Insurance we are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyways. You may be just the right candidate for this or other roles. - 11 Days Ago
Claims examiner
- UST
-
Columbus, OH
FULL_TIME
- Claims Examiner UST HealthProof is looking for Claims Examiner, reporting to the Claims Team Leader, the Examiner is responsible for adjudication of healthcare claims utilizing employer and payer spec...
- Just Posted
Claims Examiner
- Sheakley Group, Inc
-
Cincinnati, OH
FULL_TIME
- Job Summary The main responsibility of this position is to assist the Workers' Compensation Account Management Team with their administrative needs. We offer employees a range of perks including but n...
- 4 Days Ago
Workers' Compensation Claims Examiner
- V+A Risk Services
-
Toledo, OH
FULL_TIME
- Workers Compensation Claims Examiner Position Available V A Risk Services is an Ohio based TPA for workers’ compensation claims management services. We have stood ready to serve our valued clients sin...
- Just Posted
Claims Examiner - 100% Remote
- S&S Healthcare
-
Cincinnati, OH
FULL_TIME
- S&S Health is a premier healthcare administration company located in Cincinnati, Ohio. We offer self, level, and fully funded solutions that lower costs while improving outcomes with a consumer-centri...
- 1 Day Ago
Medical Claims Examiner
- Wipro Limited
-
CANFIELD, OH
FULL_TIME
- 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 sat...
- 2 Days Ago
Claims Examiner, Sr. jobs at Popular Companies
VCCO #24-164: Claims Investigator Trainee (Newark, NJ)
- New Jersey Attorney General's Office
-
Newark, NJ
- The New Jersey Attorney General’s Office – Victims of Crime Compensation Office is seeking two (2) enthusiastic individu...
- 4/17/2024 12:00:00 AM
Claims Investigator
- Daniel J. Hannon and Associates, Inc.
-
Forest Hills, NY
- Job Description Job Description Company Info: Daniel J. Hannon & Associates, Inc. (DJH) is a Long Island-based insurance...
- 4/17/2024 12:00:00 AM
Claims Investigator
- Daniel J. Hannon and Associates, Inc.
-
Buffalo, NY
- Job Description Job Description Company Info: Daniel J. Hannon & Associates, Inc. (DJH) is a Long Island-based insurance...
- 4/17/2024 12:00:00 AM
DEDUCTIONS/CLAIMS INVESTIGATOR
- Hiring Now!
-
Greeley, CO
- Deductions/Claims InvestigatorPurpose and Scope/General Summary: We are looking for a Deductions/Claims Investigator for...
- 4/16/2024 12:00:00 AM
Claim Examiner
- Pyramid Consulting, Inc
-
Garden City, NY
- Immediate need for a talented Claim Examiner. This is a 6+ Months contract opportunity with long-term potential and is l...
- 4/13/2024 12:00:00 AM
Claims Examiner –Remote
- Generis Tek Inc
-
North Philadelphia, PA
- Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
- 4/13/2024 12:00:00 AM
Claims Examiner –Remote
- Generis Tek Inc
-
Chicago, IL
- Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
- 4/13/2024 12:00:00 AM
Claims Examiner –Remote
- Generis Tek Inc
-
Columbus, OH
- Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
- 4/13/2024 12:00:00 AM
About Ohio
Ohio /oʊˈhaɪoʊ/ (listen) is a Midwestern state in the Great Lakes region of the United States. Of the fifty states, it is the 34th largest by area, the seventh most populous, and the tenth most densely populated. The state's capital and largest city is Columbus.
The state takes its name from the Ohio River, whose name in turn originated from the Seneca word ohiːyo', meaning "good river", "great river" or "large creek". Partitioned from the Northwest Territory, Ohio was the 17th state admitted to the Union on March 1, 1803, and the first under the Northwest Ordinance. Ohio is historically know...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner, Sr. jobs
$60,923 to $78,547
Most Popular Cities in Ohio for Claims Examiner, Sr. Jobs
What does a Claims Examiner, Sr. do?
Claims Examiner, Sr. in Sarasota, FL
After reading this, you will have a much better idea on whether you will like working as a Property and Casualty Insurance Claims Examiner or not.
January 17, 2020
Claims Examiner, Sr. in Fairbanks, AK
Still, a good number of students health claims specialist resume have to contend with language skill barriers.
February 05, 2020
Claims Examiner, Sr. in Idaho Falls, ID
Kevin Pitts joined CIRSA a little over a year ago as a Workers’ Compensation Claims Examiner.
December 18, 2019