Claims Examiner II/III

Job Description

We are currently seeking a Claims Examiner II/III to join our team at Innovative Management Systems Incorporated. This position requires in-depth knowledge and experience in Medicare claims processing within a managed care organization, managed service organization, IPA, and/or health plan environment. The role involves accurately reviewing, researching, and analyzing professional claims for a managed service organization (MSO), making benefit determinations, and identifying root causes of claim issues.

Position Specs:

• Non-Exempt, Full-Time position with benefits eligibility including PTO, PSL, Holidays, 401(k), Flexible Spending Account, and Work/Life Balance.
• Typical schedule: Monday - Friday with flexible hours between 8:30 am - 5:30 pm.
• Salary Range: $24-$37 per hour based on experience.

Major Duties:

• Identify authorizations, adjudicate claims, and ensure accurate claim processing.
• Collaborate with other departments and providers for successful claim resolutions.
• Generate reports on claim payment errors and provider disputes.
• Attend meetings and provide feedback on claims-related matters.

Requirements:

• High School diploma with 3+ years of claims processing experience in managed care.
• Extensive knowledge of Medicare rules, medical terminology, and HCFA 1500 forms.
• Proficiency in Microsoft Office applications and strong multitasking skills.
• Excellent communication, organization, and customer service abilities.

Compensation:

Hourly wage range: $24-$37