Job Overview The Medical Claims Examiner will be responsible for handling several blocks of moderate to complex claims. The Medical Examiner is accountable for ensuring optimal claims handling and timely, accurate decisions. A strong customer focus is required to maintain customer relationships. The Medical Examiner will interact with internal and external customers including, but not limited to, claimants, employers, physicians, attorneys, etc., to gather the information to make the decision on the claim. The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the contract. Starting Pay Rate $19.58

Full Time or Part Time:

Full Time Standard Hours per

Week:

Monday - Friday, 40 hours/week

Work Schedule:

Shift starts 8:00 AM - 5:00

PM Schedule Type:

In office with hybrid flexibility after training Responsibilities Analyze insurance contract documents and systems to ensure provisions are applied correctly. Confidently evaluate and adjudicate multiple complex claim types and medical records. Gather and review medical, financial, and occupational information pertaining to the claim. Communicate clearly with the insured and/or provider routinely to provide statuses and to request information. Input sensitive information into the claim system while ensuring accuracy. Ability to solve complex claim scenarios, and the ability to manage multiple and changing priorities Demonstrate tenacity and independence with assigned claim work. Draft free-form letters involving complex subject matters. Strong emphasis on polished and professional communications. Communication may be verbal or written (paper and/or electronic). Adhere to insurance regulations and internal service level standards. Review for potential fraud. Maintain client files and confidentiality with excellent documentation and organization of data filing while insuring to maintain HIPAA laws and regulations. Answer phones and communicate with caller; estimated 5-20 calls per day. Proven skills in positive and effective interaction with challenging customers Stay updated on industry trends, best practices, and product/service updates through training sessions, self-study, and team meetings to enhance knowledge and performance Job Requirements Basic Qualifications 5 or more years' experience in insurance claims experience. Advanced analytical and problem-solving skills. Demonstrated proficiency using Microsoft systems. Strong written and verbal communication skills. Other Qualifications General understanding of Medical and Disability operations. General medical knowledge and investigative skills. Advanced understanding of policy coverages including, disability, medical and waiver riders Entering confidential data into claims system. Monitoring reports to ensure adherence to internal service level standards. Interacting with claimants and insurance carriers as needed. Adjudicating moderate to complex claims.

High School Diploma/GED Job Type:

Full-time Pay:

From $19.58 per hour

Benefits:

401(k) Health insurance Life insurance Paid time off

Education:

High school or equivalent (Required)

Location:

Winston-Salem, NC 27106 (Required)

Work Location:

In person