Claim Examiner​/Orlando FL

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Business Claim Examiner

Division Pharmaceutical

Pay Negotiable

Contract 6 Month

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 .

Thanks & Regards,