Joint Planner

JOB SUMMARY

The claims examiner is responsible for ensuring timely and accurate adjudication of Medicare Supplement claims within federal regulatory guidelines and established organizational standards. The examiner will be expected to make appropriate claim determinations based on policy provisions.

• Review Claim Documents for completeness and validity to adjudicate claim within organizational guidelines.
• Request additional information needed to process claims from providers and members. Retrieve images from Onbase and Outlook.
• Manage claims from inception to resolution within designated limit. Meet or occasionally exceed established standards for productivity and quality.
• Maintain claim turnaround time set.
• Communicate trends and other opportunities for improvement to Management.
• Maintain accuracy and quality with a less than 2% rate.
• Ensure all appropriate documentation, including any missing documentation is concise.
• Reports to work on time and maintains a satisfactory attendance record.
• Attend and actively participate in departmental meetings, trainings and coaching sessions.
• Maintain patient privacy and confidentiality in accordance with HIPAA standards.
• Seek and takes advantage of development opportunities that will improve technical/functional expertise.
• Resolves routine problems within established guidelines and seeks assistance as needed, or required.

• Experience in billing and/or claims
• Ability to compile and review information to make sound decisions
• Skilled in performing intermediate arithmetic calculations
• Excellent typing skills
• Proficiency in Microsoft Office Suite (i.e. Outlook, Excel, Word) and other basic computer programs
• Ability to thrive in fast paced environment while working independently and with limited supervision
• Positive team oriented attitude with flexibility to adjust to changes as they arise
• Ability to multi-task
• High attention to detail and accuracy
• Working Knowledge of Onbase, and Mainframe

• High School or 1-2 years related experience/training; or a combination
• Knowledge of insurance industry, billing and claims handling experience, preferred
• Billing/Coding experience is a plus