Claims Examiner

Claims Examiner

A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims need to be completed adhering to required TAT and quality SLA.

Key Responsibilities:

• Excellent Analytical skills to review claims based on rules and workflows.
• Good comprehension skills to adjudicate claims as per Policies and Procedures.
• Complete team player.

Key Performance Indicators:

• Ensuring that the key Service Level Agreements are met consistently without any exceptions.
• Achieve set Production goals.
• Adherence to departmental and company rules and regulations.

Qualifications:

High School diploma or equivalent required.

Competencies & Skills:

• Exceptional verbal and written communication and interpersonal skills, including negotiation and active-listening skills.
• Exceptional analytical and problem-solving skills.
• Strong attention to detail with a commitment to accuracy.
• Ability to adapt to change in a dynamic fast-paced environment with fluctuating workloads.
• Basic mathematical skills.
• Intermediate typing skills.
• Basic computer skills.
• Knowledge of medical terminology, ICD-9/ICS-10, CPT, and HCPCS coding, and HIPAA regulations preferred.
• Knowledge of insurance policies, regulations, and best practices preferred.

Additional Qualifications:

• Ability to download 2-factor authentication application(s) on personal device, in accordance with company and/or client requirements.
• Ability to pass the required pre-employment background investigation, including but not limited to, criminal history, work authorization verification and drug test.

Work Environment:

This position may work onsite or remotely from home.

Physical Demands:

• Must be able to regularly or frequently talk and hear, sit for prolonged periods, use hands and fingers to type, and use close vision to view and read from a computer screen and/or electronic device.
• Must be able to occasionally stand and walk, climb stairs, and lift equipment up to 25 pounds.

Firstsource is an Equal Employment Opportunity employer. All employment decisions are based on valid job requirements, without regard to race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, age, disability, genetic information, veteran status, or any other characteristic protected under federal, state or local law. Firstsource also takes Affirmative Action to ensure that minority group individuals, females, protected veterans, and qualified disabled persons are introduced into our workforce and considered for employment and advancement opportunities.

Firstsource Solutions is a leading provider of customized Business Process Management (BPM) services. Firstsource specialises in helping customers stay ahead of the curve through transformational solutions to reimagine business processes and deliver increased efficiency, deeper insights, and superior outcomes.