Claims Examiner Senior 160

Title: Claims Examiner Senior
Location: Irving TX 75039 - Onsite
Shift: 8 AM - 5 PM -Monday-Friday
Duration: 13 Weeks
Pay Rate: $24/hr.

Notes: Proof of education; High School Diploma
Minimum of 3 years experience processing medical claims in the healthcare industry.

The Claims Examiner Senior is responsible for reviewing analyzing researching and resolving complex medical claims in accordance with claims processing guidelines and desktops as well as ensuring compliance with federal regulations. This role works in conjunction with Business Configuration Network Management Provider Data Complaints Appeals and Grievances as well as other operational departments to ensure validation and quality assurance of claims processing.

Responsibilities:

• Meets expectations of the applicable Competencies: Leader of Self Leader of Others or Leader of Leaders.
• Analyze medical claim information and take appropriate action for payment resolution in accordance with policies and procedures desktops processing guidelines and federal regulations.
• Process medical claims submitted on CMS-1500 and CMS-1450/UB-04 claim forms from facilities physicians Home Health Durable Medical Equipment providers laboratories etc.
• Work claim projects resulting from overpayments or underpayments related to manual processing errors benefit updates and/or contract fee schedule changes.
• Process provider refunds reconsiderations and direct member reimbursements.
• Process medical claim adjustments recovery of claim overpayments and execution of claim batch adjudication.
• Solve moderately complex claims and escalate issues to the Claims Team Lead Supervisor or Manager.
• Assist with database improvements and testing for system upgrades conversions or implementation of new processes.
• Serves as a resource to assist

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We offer competitive compensation and comprehensive benefits including medical dental vision and retirement options.

TalentBurst is an equal opportunity employer committed to an inclusive and diverse workforce.