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Claims Examiner II (Operations

Company: Cenpatico
Location: Little Rock
Posted on: December 4, 2019

Job Description:

Claims Examiner II (Operations) USA-Arkansas-Little Rock Position Purpose: Evaluates routine and non-routine claims within various product lines to determine type and amounts of benefit payable. Performs all authorized duties to the processing of such claims assigned, consistent with applicable policies, procedures and department guidelines. * Determines level of reimbursement based on established criteria, provider contract, plan and employer group provisions, for multiple products. * Processes all claims eligible or ineligible for payment accurately and conforming to quality, production standards and specifications. * Documents provider claims/billing forms to support payments/decisions. Matches authorizations to claims, maintains current desk procedural and reference materials. * Reviews appeals and complaints; researches any missing or required information. Responds to providers, members, or other company departments to process and resolve the claim issue. * Identifies dual coverage, potential third party liability cases and reinsurance cases. Requests additional information that is relevant to savings/recovery. * May assist in system testing, changing, analyzing and reporting of specific enhancements for assigned product line. Education/Experience: High School Diploma or equivalent required. Three years health claims examiner and one year multiple product experience required Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Claims Operations Full-time

Keywords: Cenpatico, Little Rock , Claims Examiner II (Operations, Other , Little Rock, Arkansas

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