Summary: Claims Examiner I - Responsible for the review, evaluation and processing of medical claims. Applies proper claim concepts, rules and practices, ensuring accuracy and timeliness of claim payments through demonstrated knowledge of medical terminology, health insurance plans and medical billing concepts. Willingness to learn different claim platforms within eviCore and client claim platforms when necessary. Display initiative and ability to work independently on investigation and research of claim inquiries and refer questionable claims appropriately for escalation. Confirm member eligibility and claim pricing. Verify authorization and service appropriateness. Comply with departmental policies and ensure proper guidelines were followed during claim processing phases.
What You Should Have
Minimum Education: High school diploma or equivalent
Minimum Experience required (number of years necessary to perform role) :
1 year in healthcare or medical industry related to claims processing
1 year basic health plan knowledge
1 year medical billing experience
Well organized and detail oriented.
Able to work independently and within a team environment
Strong interpersonal skills both written and oral.
Proficient with Outlook, Excel, and Word
Strong critical thinking and decision-making skills
Data entry and problem solving skills
Our Company and What We Offer
eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:
Full medical, dental, vision, and vision benefits with employer funded HSA starting day 1
Strong work/life balance with 15 days of PTO (starting) per year plus paid holidays
Education assistance and tuition reimbursement along with ample opportunities for growth
Time away from work programs including employer paid short-term and long-term disability, caregiver leave, BTO (bought-time off) options, company paid volunteer community service hours, and more
Onsite fitness facilities, casual dress code- wear your jeans to work, and two comprehensive employee discount programs
Health coaching, Employee Assistance Program, resiliency and stress management solutions, Adoption Assistance Program and additional resources to support your well-being
Life & Accidental Death Dismemberment and additional Accidental Injury, Critical Illness, and Hospital Care Insurance
401k retirement plan with company match of 50% employee contributions up to 6%
And so much more! Check out evicore.com/careers to see all of the perks and benefits we offer.