CLAIMS EXAMINER at HealthSmart in Charleston, West Virginia

Posted in Other 4 days ago.

Job Description:

About HealthSmart

HealthSmart is the premier provider of customizable and scalable health plan solutions for self-funded employers. We reduce costs and improve outcomes, all the while treating our health plan members with dignity and respect. But that's just the beginning of our story - We make differences in peoples' lives every single day!

Our HealthSmart team understands the difference we make when treating others with dignity and respect, which is why we embody our mission by promoting a diverse and inclusive culture.

We're a company of innovators.

We deliver health benefit plans and solutions to provide worry-free, self-funded plan administration, quality coverage, and innovative care.

We provide care management services that change lives and helps employers and members take control of healthcare costs.

HealthSmartRx Solutions delivers extremely attractive pharmacy benefits with an Rx discount program.

Our Network Solutions group offers national, comprehensive provider networks to provide member access to the right care.

HealthSmart Casualty Claims Solutions leverages technology, robust information and unmatched experience to deliver innovative casualty claims management solutions with outstanding results.

We offer business intelligence and web-based reporting. Plus, we offer a variety of health and wellness initiatives and even onsite employer clinics.


At HealthSmart, the Claims Examiner will review and settle medical claims for benefit plans in accordance to regulatory requirements and business standards. Payment errors and other irregularities should be reported, well-documented, and resolved by following proper business processes and procedures. Preexisting knowledge and experience handling multi-claim and medical claims is required.

Essential Skills

  • 5 years' experience in related healthcare field

  • Multi-Claim experience

  • Medical claims experience

  • Microsoft office (Word and Excel)

  • Types accurately at 55 WPM

  • High School Diploma (College courses preferred)

Essential FunctionsReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

  • Process claims timely and accurately in full accordance of health plan guidelines

  • Alert management promptly of any identified issues that impact quality and production

  • Process claims in accordance with current and relevant provisions of applicable plan documents

  • Prepare correspondence reports in a clear and concise manner for business files

  • Monitor and follow-up on pending claims activity immediately to ensure accuracy

  • Exceed minimum production averages with accurate payment and procedure reports

  • Provide phone back-up for the Customer Service department as needed

  • Assist manager with ad-hoc reports and projects when requested

Physical Requirements

  • While performing the duties of this job, the employee is frequently required to sit, talk, and hear.

  • The employee is occasionally required to walk; use hands and fingers to feel, handle, or operate objects, tools, or controls; and reach with hands and arms.

  • The employee must occasionally lift and/or move up to 30 pounds.

  • Specific vision abilities required by this job include close vision and the ability to adjust focus.

  • The work is performed primarily in an office setting.

  • The noise level in the work environment is moderate

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position

HealthSmart provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.