BRMS · 11 hours ago
CLAIMS EXAMINER
Folsom,CA,US
Full-time
Onsite
Mid Level
3+ years expBRMS is seeking a Claims Examiner I responsible for ensuring claims are coded and processed correctly while meeting production requirements. The role involves adjudicating medical claims, maintaining productivity standards, and resolving claims escalations.
FitnessHealth CareWellness
Responsibilities
Compares data on claim with internal policy and other company records to ascertain completeness and validity of claim
Comprehensive understanding of employee benefits for medical, dental and vision plans
Adjudicates medical claims, applies coordination of benefits as outlined in plan guidelines and works with providers to gather the necessary documents to make final payment determination on claims
Ensures all claims are coded properly
Examines Summary Plan Document, claim adjustors' reports or similar claims/precedents to determine extent of coverage and liability
Maintains high quality standards to avoid paying claim incorrectly
Maintains productivity standards set by Management
Refers most questionable claims for investigation to claim examiner II for review and processing
Research and resolve paid and denied claims escalations from internal sources and/or TIPS ticketing system when assigned
Works from the claims queue manager to process & releases claims for adjudication and payment within 3-5 days of receipt
Performs other duties and responsibilities as assigned by Management
Qualification
Required
Excellent written and verbal communication skills
Strong analytical skills and problem-solving skills
Must be dependable and maintain excellent attendance and punctuality
Must be able to perform data entry operations quickly and accurately
Ability to grow with changing demands of the position and the company
Strong computer skills, including Word, Excel, and Outlook
Successful candidates must have experience processing medical claims for an insurance company or third party administrator
Must be highly proficient in ICD-10, CPT, and HCPCS codes
Associate's degree (A. A.) or equivalent from two-year college or technical school
Must have 3-5 years employee benefits industry/processing claims experience or equivalent combination of education and experience
Ability to read, speak, and write effectively in English
Ability to interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
Ability to write routine reports, meeting notes, project documentation, and correspondence
Ability to speak effectively before customers or employees of organization
Ability to effectively address or resolve customer service issues within guidelines of the position
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form
Ability to deal with problems involving several concrete variables in standardized or non-standardized situations
Valid, class C license in state working with no adverse driving record
Company
BRMS
BRMS is a health & wellness company offering online benefit administration solutions.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Matt Schafer
Chief Executive Officer
Company data provided by crunchbase