HCA Healthcare
Description
Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump‑start your career as a Senior Claims Examiner today with Work from Home.
Benefits
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long‑term care coverage, moving assistance, pet insurance and more.
Free counseling services and resources for emotional, physical and financial wellbeing.
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service).
Employee Stock Purchase Plan with 10% off HCA Healthcare stock.
Family support through fertility and family building benefits with Progyny and adoption assistance.
Referral services for child, elder and pet care, home and auto repair, event planning and more.
Consumer discounts through Abenity and Consumer Discounts.
Retirement readiness, rollover assistance services and preferred banking partnerships.
Education assistance (tuition, student loan, certification support, dependent scholarships).
Colleague recognition program.
Time Away From Work Program (paid time off, paid family leave, long‑ and short‑term disability coverage and leaves of absence).
Employee Health Assistance Fund that offers free employee‑only coverage to full‑time and part‑time colleagues based on income.
Eligibility for benefits may vary by location.
Job Summary Senior Claims Examiner primary function is to ensure correct adjudication of all complex claims for SCCIPA contracted plans.
Responsibilities
Adjudicate all types of claims, resolving all system edits and audits for hardcopy and electronic claims.
Resolve provider and eligibility issues relating to received claims.
Generate emergency reports/authorizations for all received claims which lack prior authorization.
Adjudicate third‑party liability and coordination of benefit claims in accordance with policy.
Review stop loss reports and identify members who are nearing reinsurance levels.
Identify potential system programming issues and report issues to supervisor.
Provide technical support and training for claims processors.
Recognize and appropriately route claims for carved‑out services according to plan contracts.
Understand plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and process claims using this knowledge.
Understand general ledger accounts posting of claims information to the appropriate accounts.
Work with Customer Service and Provider Services to assist on large claim projects and adjustments.
Assist with benefit/plan interpretation with customer via the cut‑log system when necessary.
Adjust complex claims and assist other examiners.
Perform other duties as assigned.
Knowledge, Skills and Abilities
Ability to communicate well with supervisors and co‑workers.
Ability to analyze claim issues and “trouble‑shoot” claim problems.
Ability to work in a high volume, production‑oriented environment.
Detail‑oriented with an ability to sit for an extended period of time.
Ability to work under demanding performance standards for production and quality.
Technical competence with claims processing software.
Ability to understand and implement complex claims procedures.
Medical terminology.
Knowledge of HEDIS, DOC, HCFA and NCQA requirements.
Ability to act as a resource and/or trainer for claims processors.
Education High school diploma or equivalent required.
Experience
Three to five years of experience processing regular and complex claims.
Knowledge of ICD‑9, CPT, HCPC, and revenue coding required.
Apply today for this exciting opportunity. We review all applications promptly. Highly qualified candidates will be contacted for interviews.
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
#J-18808-Ljbffr
Benefits
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long‑term care coverage, moving assistance, pet insurance and more.
Free counseling services and resources for emotional, physical and financial wellbeing.
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service).
Employee Stock Purchase Plan with 10% off HCA Healthcare stock.
Family support through fertility and family building benefits with Progyny and adoption assistance.
Referral services for child, elder and pet care, home and auto repair, event planning and more.
Consumer discounts through Abenity and Consumer Discounts.
Retirement readiness, rollover assistance services and preferred banking partnerships.
Education assistance (tuition, student loan, certification support, dependent scholarships).
Colleague recognition program.
Time Away From Work Program (paid time off, paid family leave, long‑ and short‑term disability coverage and leaves of absence).
Employee Health Assistance Fund that offers free employee‑only coverage to full‑time and part‑time colleagues based on income.
Eligibility for benefits may vary by location.
Job Summary Senior Claims Examiner primary function is to ensure correct adjudication of all complex claims for SCCIPA contracted plans.
Responsibilities
Adjudicate all types of claims, resolving all system edits and audits for hardcopy and electronic claims.
Resolve provider and eligibility issues relating to received claims.
Generate emergency reports/authorizations for all received claims which lack prior authorization.
Adjudicate third‑party liability and coordination of benefit claims in accordance with policy.
Review stop loss reports and identify members who are nearing reinsurance levels.
Identify potential system programming issues and report issues to supervisor.
Provide technical support and training for claims processors.
Recognize and appropriately route claims for carved‑out services according to plan contracts.
Understand plan contracts, provider pricing, member eligibility, referral authorization procedures, benefit plans and capitation arrangements and process claims using this knowledge.
Understand general ledger accounts posting of claims information to the appropriate accounts.
Work with Customer Service and Provider Services to assist on large claim projects and adjustments.
Assist with benefit/plan interpretation with customer via the cut‑log system when necessary.
Adjust complex claims and assist other examiners.
Perform other duties as assigned.
Knowledge, Skills and Abilities
Ability to communicate well with supervisors and co‑workers.
Ability to analyze claim issues and “trouble‑shoot” claim problems.
Ability to work in a high volume, production‑oriented environment.
Detail‑oriented with an ability to sit for an extended period of time.
Ability to work under demanding performance standards for production and quality.
Technical competence with claims processing software.
Ability to understand and implement complex claims procedures.
Medical terminology.
Knowledge of HEDIS, DOC, HCFA and NCQA requirements.
Ability to act as a resource and/or trainer for claims processors.
Education High school diploma or equivalent required.
Experience
Three to five years of experience processing regular and complex claims.
Knowledge of ICD‑9, CPT, HCPC, and revenue coding required.
Apply today for this exciting opportunity. We review all applications promptly. Highly qualified candidates will be contacted for interviews.
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
#J-18808-Ljbffr