Medical Health Claims Examiner or Processor
Chesterfield Companies is a Third party administrator and has an opening in the area South of Akron for an in-house Medical Health Claims Examiner or Processor. This position processes medical charges to ensure appropriate reimbursement in accordance with state fee schedules or usual and customary guidelines in non-fee states. Promotes and provides customer service. Processes medical charges to ensure appropriate reimbursement in accordance with state fee schedules or usual and customary guidelines in non-fee states.
In the office - Monday through Friday from 7:00 am to 4:00 pm.
What you will be doing:
1. Processes first and third party casualty medical claims in accordance with company policy and applicable federal and state regulations. Excellent understanding of claims procedures, rules and guidelines, and all aspects of claims adjudication (ex. COB rules, multiple surgeries, lab/radiology, etc.)
2. Audits bills for detection of possible fraud;
3. Remains current on coding updates, practices and legislation for assigned state(s). Knowledge of all aspects of benefits claims processing and basic claims adjudication principles and procedures, medical terminology, Current Procedural Terminology (CPT) and International Classification of Diseases (ICD9)
4. Maintains comprehensive understanding of the auditing system in order to recognize errors and notifies appropriate persons for error correction.
5. Prepares and submits administrative reports as required.
6. Recognizes appropriate diagnosis and procedure codes submitted by medical providers and selects or assigns, as needed, corrects codes for entry into the medical bill auditing system.
7. Coordination of Benefits
8. Delivers a positive customer service experience to all internal and external current customers. Performing customer service responsibilities for providers and members as needed.
9. Other duties as assigned.
What is required from you:
Education: High school studies; some post high school course work preferred.
Experience: Two-years of medical health claims handling or processing experience required.
Knowledge: General knowledge of insurance processing activities and operational functions. Familiarity with claims policies and procedures and medical terminology.
Must have excellent interpersonal skills and ability to work in a team-oriented environment
Strong oral and written communications
What is in it for you:
Join an established company that appreciates its people
Excellent benefits package
Medical insurance, Dental insurance, Vision insurance