A Claims Examiner evaluates insurance claims in accordance with applicable contracts and government regulations within their insurance type. Determines member eligibility and financial responsibility of the insurance company.
Senior Health Insurance Claims Auditor Seminole Tribe of Florida - 4.0 Hollywood, FL Job Details Full-time $36 - $40 an hour 1 day ago Benefits Health insurance Dental insurance 401(k) Paid time off Employee assistance program Vision insurance 401(k) matching Life insurance Qualifications Customer service Medical coding Certified Professional Coder Driver's License Bachelor's degree Organizational skills Business Administration Productivity software Insurance claims auditing Business Healthcare claims compliance audits Full Job Description The Seminole Tribe of Florida's Health Plan Team is responsible for providing quality Medical and Dental Health care providers to the Tribal Community while assuring cost-effectiveness and excellent customer service. This program functions under the leadership of the Health & Human Services department and addresses healthcare challenges while ensuring the best customer service experience whether in claim payment, claims appeals, pre-certifications, contract negotiations, coordination of benefits with plans or networks and eligibility. Quality patient care and payments are at the forefront.
Learn more at https:
//www.semtribe.com/stof/services/health-and-human-services . Position Summary The incumbent in this position is responsible for being the team lead in auditing and reviewing Tribal benefit activities and processing health claims, including analyzing payments, procedures and guidelines of benefits. The individual investigates the validity of claims, reviews and settles benefit claims and processes claims for payment ensuring that Tribal Member's health insurance claims are processed and resolved in a timely manner. The individual provides assistance and guidance to the Health Plan Program Manager, Health Plan team, Health & Human Services Leadership, Tribal Members and other relating employees on health insurance claims. The incumbent maintains accurate case files and issues reports on general claims activity.
Qualifications / Requirements
Bachelor's degree in Health Administration, Accounting, Business Administration, Human Resources Management or related field is required. A minimum of three (5) years of experience working as team lead, supervisor, claims auditor, benefits coordinator or experience processing insurance claims is required with at least two (2) years of experience as a Certified Professional Coder (CPC), is required. An equivalent combination of education/training and experience will be considered. Possession of a valid Florida Driver's License is required. Demonstrate excellent customer service and organizational skills. Demonstrate excellent written and verbal communication skills. Demonstrate proficiency utilizing Microsoft software packages. Ability to work a flexible schedule including evenings, weekends and holidays. About STOF The Seminole Tribe of Florida is a federally recognized Native American Tribe and sovereign Tribal Government, dedicated to providing high quality care and services to its members who reside on reservations throughout South Florida; Hollywood, Big Cypress, Brighton, Fort Pierce, Immokalee, Tampa and two satellite offices located in Naples and Miami (Trail). With our Headquarters based in Hollywood, Florida, The Seminole Tribe of Florida has approximately 2,000 employees spread throughout our Reservations. The Tribe has developed numerous employment opportunities through a broad range of services such as Accounting, Education, Public Works, Media Productions, Community Planning, Recreation, Credit & Finance, Health, Museum, Public Safety, Legal, Information Technology and Elder Services, along with many others. The Seminole Tribe of Florida has more non-contiguous reservations than any tribe in North America. Take a walk through our six reservations by visiting us online at www.semtribe.com.
Job Type:
Full-time Pay:
$36.00 - $40.00 per hour
Benefits:
401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Life insurance Paid time off Vision insurance
Education:
Bachelor's (Required)
Experience:
Professional Coding:
2 years (Required)
Claims Auditor/Processing Insurance Claims:
4 years (Required)
License/Certification:
Florida Driver's License (Required) Certified Professional Coder (Required) Ability to
