Claims Examiner

Description

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Claims Examiner today with Work from Home.

Work from Home offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free Air Med medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long‑term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long‑ and short‑term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee‑only coverage to full‑time and part‑time colleagues based on income.

Learn more about Employee Benefits

Note:
Eligibility for benefits may vary by location.

Come join our team as a Claims Examiner. We care for our community! Just last year, HCA Healthcare and our colleagues donated 13.8 million dollars to charitable organizations. Apply Today!

The Claims Examiner primary function is to ensure correct adjudication of all claims for SCCIPA contracted plans.

DUTIES INCLUDE BUT NOT LIMITED TO:

• Adjudicate claims, resolving all system edits and audits for hardcopy and electronic claims.
• Resolve provider and eligibility issues relating to received claims.
• Generate emergency reports/authorizations for all received claims which lack prior authorization.
• Adjudicate third party liability and coordination of benefit claims in accordance with policy.
• Review stop loss reports and identify members who are nearing reinsurance levels.
• Identify potential system programming issues and report issues to supervisor.
• Provide technical support and training for claims processors.
• Recognize and appropriately route claims for carved out services according to Plan contracts.
• Understand Plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and process claims using this knowledge.
• Understand general ledger accounts and posting of claims information to the appropriate accounts.
• Perform other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:
This position requires the following minimum requirements:

• Ability to communicate well with supervisors and co‑workers
• Ability to analyze claim issues and “trouble shoot” claims problems
• Ability to work in a high volume, production‑oriented environment
• Detail oriented with an ability to sit for extended period of time
• Ability to act as a resource and /or trainer for claims processors
• Ability to work under demanding performance standards for production and quality
• Technical competence with claims processing software
• Ability to understand and implement complex claims procedures

EDUCATION:

• High school diploma or equivalent
• Knowledge of ICD‑9, CPT, HCPC, and Revenue Coding
• Medical terminology preferred
• Knowledge of DOC and HCFA…