Medical Claims Examiner/senior Claims Examiner
Made appropriate claim decisions based on various contracts and plan provisions. Included evaluation of claim per plan provisions, determination of eligibility, verification of data input, identification of correct benefit level, calculation of fee schedule, and performing claim corrections.
- Made outgoing phone calls to verify or obtain information regarding a claim to ensure timely processing.
- Received incoming calls from vendors, customers, brokers, groups, and providers. Successfully analyzed the caller's needs, researched information, answered questions, and resolved issues.
- Mentored others on the team and served as a subject matter expert or contact for specific accounts.
- Verified on-line records. Maintained accurate customer information by making corrections or referred information to appropriate person to keep the customers information accurate.
- Met and exceeded the Company's dollar quality goal of 99.5% in accurately processing claims and paying the required amount of claims per day of 115 drafts.