Claim Examiner // Orlando FL 32822

Timings Mon - Fri between 8.00AM – 5.00PM
POSITION OVERVIEW
·Verify member submitted claims forms, member's eligibility & pharmacy information is complete & accurate, updating system information as needed.
·A high data entry proficiency is expected in order to provide accurate & timely processing of claims submitted by member, pharmacy or agencies.
·Moderate knowledge of drugs & drug terms used daily.
·Process claims according to client specific guidelines while identifying claims requiring exception.
·Navigate daily through several platforms to research & finalize claim submissions.
·Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.
·Adhere to strict HIPPA regulations especially when communicating to others outside of ESI.
·Prioritize & coordinate influx of daily workload for claims processing, returned mail & outgoing correspondence & e-mails to assure required turnaround time is met.
·Assess accuracy of system adjudication & alert management of potential problems affecting the integrity of claim processing.
·Analyze claims for potential fraud by member or pharmacy.
·May be required to work on special projects for claims team.
If you are available and interested then please reply me with your “ Chronological Resume” and call me on (678)-405-3590 .
Thanks & Regards,
Ranadheer Murari | Team Recruitment | Mindlance, Inc. | W:678 405 3590
ranadheerm@mindlance .com