Claims Examiner - Jefferson Health Plan

About the role

Working under general supervision, the Claim Examiner adjudicates medical claims, in accordance with Health Partners' policies and procedures. Job Duties Able to work in a constant state of alertness and safe manner Accurately adjudicates claims in compliance with data entry rules, On Line Processing Rules and contractual agreements. Reviews pended claims on a daily basis, assuring that all appropriate documentation is completed before adjudication. Accurately completes service forms for pended claims and routes to designated areas for resolution. Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes. Follow established procedures and guidelines for claims processing and high dollar claim review. Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy. Keeps current with Claims Department policies and procedures. Assist the unit in meeting and maintain performance standards. Minimum Qualifications High School Diploma/GED Ability to maintain strict confidentiality of patient information obtained in the performance of job function Preferred Qualifications 2 years claims processing experience or provider billing experience Excellent communication skills required-both oral and written Basic understanding of computer applications General understanding of the principles of Managed Care Physical Demands Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR. Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require. Work Shift Workday Day (United States of America) Worker Sub Type Regular Employee Entity Health Partners Plans, Inc. Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

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Job Details Working under general supervision, the Claim Examiner adjudicates medical claims, in accordance with Health Partners' policies and procedures. Job Description

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