Claims Examiner jobs in Montana
Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
Recently Added Claims Examiner jobs
Health Claims Examiner
- Allegiance Benefit Plan Management
-
Missoula, MT
FULL_TIME
-
- NO EXPERIENCE NECESSARY- WE WILL TRAIN**
Allegiance offers full-time positions with evenings, weekends, and holidays off and a multi-faceted benefits package.
We pride ourselves in having a reputation for top-notch customer service. Make a difference. Start your career with Allegiance today!
Position Responsibilities
The Claims Examiner is responsible for the accurate and timely processing of medical, dental, vision and pharmacy claims. The incumbent is expected to provide courteous and prompt responses to customer inquiries.
The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.
Essential Job Functions
Essential job functions include the following. Other functions may be assigned as business conditions change.- Verifies the accuracy and receipt of all required documentation for each claim submitted.
- Collaborates with providers, plan participants, other claims payers, or any other party necessary to obtain information necessary to accurately process a claim.
- Analyzes information necessary for processing. This includes, but is not limited to, general participant and provider information, managed care affiliation, diagnosis codes, dates, place, type of service, procedure codes, and charges.
- Assures that the system processes the claim correctly and determines payment according to the plan as written.
- Word-processes correspondence to plan participants and providers in reference to pre-determinations and in response to basic benefit questions.
- Answers telephone calls from plan participants, group contacts, and customer service representatives pertaining to benefits and claims inquiries.
- Resolves problematic claims with the assistance of the Team Leader, Claims Manager and/or the Director of Claims.
- Assigns critically ill patients to large case management. Assists the case manager with direct negotiation and the efficient use of benefits.
- Assists other examiners as needed due to workload requirements, including assigned back-up when examiners are absent.
- Aids the Team Leader and/or the Claims Manager in the resolution of claim appeals and disputes by providing documentation for review.
- Researches, calculates and requests refunds when necessary.
- Contributes to the daily workflow with regular and punctual attendance.
- Thoroughly researches and completes renewal reports in a timely manner in consultation with the Marketing Department.
- Process eligible claims on groups before the end of their stoploss contract renewal period.
- Assists the Legal Department with subrogation claims as necessary.
- Attends various group meetings as required.
- Assists with audits as needed
- Assists with plan benefit set-up and changes as needed.
Performs related or other assigned duties as required or directed
Supervision Exercised
None.
Physical Working Conditions
Physical requirements are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sitting 80%
Reaching Some
Standing 10%
Manual Dexterity High
Walking 10%
Telephone Yes
Kneeling Some
Computer Screen High (visual acuity corrected to 20/30)
Bending Some
Lifting up to 30 pounds
Job Specifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Education: High school graduation or GED required. College degree and/or training in medical terminology preferred.
Certification(s) Required: Upon hire, complete fraud training provided by the Company.
Minimum Experience: Experience in claims processing, medical billing, insurance, or health services preferred. Familiarity with group health benefits preferred.
Other Qualifications
Excellent oral and written communication skills required.
PC skills, including Windows and Word. Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. Must be able to adapt to software changes as they occur.
Typing ability of 45 wpm net.
Knowledge of medical terminology and basic health insurance concepts.
Excellent listening skills.
Basic mathematical skills.
High level of interpersonal skills to work effectively with others.
Ability to organize and recall large amounts of detailed information.
Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
Ability to meet productivity standards with 99% financial accuracy and 95% procedural accuracy.
Thorough knowledge of claims processing procedures and requirements.
Ability to project a professional image and positive attitude in any work environment.
Ability to comply with privacy and confidentiality standards.
Ability to be flexible, work under pressure and meet deadlines.
Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
Ability to operate typical office equipment.
Working knowledge of general office procedures.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel as classified.- Allegiance Benefit Plan Management, INC is an Equal Opportunity Employer. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
Job Posted by ApplicantPro - NO EXPERIENCE NECESSARY- WE WILL TRAIN**
- 12 Days Ago
Senior Flood Claims Examiner
- Torrent Technologies
-
Kalispell, MT
FULL_TIME
- Torrent Technologies is the leading flood insurance administrator in the US. Its integrated suite of business software platforms along with customer-focused service and support solutions have revoluti...
- 12 Days Ago
MT - 1099 Property Claims Adjuster
- Copper Claims Services, Inc.
-
Helena, MT
FULL_TIME
- 1099 Property Claims AdjusterCopper Claims Services is a quickly growing independent loss adjusting firm based out of Irvine, CA.Copper Claims Services excels in providing custom claims solutions for ...
- 18 Days Ago
Title Examiner
- Flathead Premier Title Company, LLC
-
Whitefish, MT
FULL_TIME
- **Job Overview:** We are seeking a detail-oriented Title Examiner to join our team. The Title Examiner will be responsible for examining public records and property titles to ensure their legal validi...
- 5 Days Ago
Butte Driver Examiner
- Montana Department of Justice
-
Butte, MT
FULL_TIME
- If you enjoy working with people, we encourage you to apply for this position. This position is eligible for the $1.50 increase July 1, 2024. Salary: $ 20.05 hourly State of Montana benefits! A Driver...
- 5 Days Ago
Part-Time CDL Skills Examiner
- Montana Technological University
-
Butte, MT
PART_TIME
- $25.00/Hour (up to 19 hours per week)Montana Technological University provides a comprehensive benefits package for all eligible positions that includes health, dental and vision insurance, mandatory ...
- 11 Days Ago
Claims Examiner jobs at Popular Companies
Claims Examiner
- Manpower
-
El Segundo, CA
- Our client, Legal Industry is seeking a Claims Examiner to join their team. As a Legal Claims Examiner you will be part ...
- 6/11/2024 12:00:00 AM
Claims Examiner
- US Tech Solutions, Inc.
-
Atlanta, GA
- Job Title: Claims Examiner Location: Remote Duration: 06 months contract (C2H) Job Description: Responsibilities: • Inve...
- 6/11/2024 12:00:00 AM
Claims Examiner
- Insight Global
-
Folsom, CA
- The Claims Examiner is responsible for ensuring claims are coded and processed correctly and for meeting production requ...
- 6/10/2024 12:00:00 AM
Claims Examiner
- Hire Up Staffing Services
-
Fresno, CA
- Hire UP Staffing is seeking an experienced Medical Claims Examiner for well established client in Fresno, CA. This posit...
- 6/10/2024 12:00:00 AM
CLAIMS EXAMINER
- San Bernardino City Unified
-
San Bernardino, CA
- Comments and Other Information To review the job description, please use the following link. https://www.schooljobs.com/...
- 6/10/2024 12:00:00 AM
Claims Examiner
- SILAC Insurance Company
-
Salt Lake City, UT
- Headquartered in Salt Lake City, Utah, SILAC Insurance Company is one of the fastest-growing insurance companies in the ...
- 6/9/2024 12:00:00 AM
Claims Examiner
- E-Solutions
-
Whittier, CA
- POSITION SUMMARY: The claims examiner reports directly to the claims manager. They are primarily responsible for the pro...
- 6/8/2024 12:00:00 AM
Claims Examiner
- Insight Global
-
Sacramento, CA
- Day to Day: The Claims Examiner 1 is responsible for ensuring claims are coded and processed correctly and for meeting p...
- 6/7/2024 12:00:00 AM
About Montana
Montana (/mɒnˈtænə/ (listen)) is a landlocked state in the Northwestern United States. Montana has several nicknames, although none are official, including "Big Sky Country" and "The Treasure State", and slogans that include "Land of the Shining Mountains" and more recently "The Last Best Place".
Montana is the 4th largest in area, the 8th least populous, and the 3rd least densely populated of the 50 U.S. states. The western half of Montana contains numerous mountain ranges. Smaller island ranges are found throughout the state. In all, 77 named ranges are part of the Rocky Mountains. The easte...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$44,928 to $59,578