Claims Examiner

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🕒 May 27

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Health Plans, Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1981

⚕️ Healthcare Insurance

💳 Fintech

🤝 B2B

Healthcare Insurance • Fintech • B2B

Health Plans, Inc. (HPI) is a leading national third-party administrator (TPA) that specializes in self-funding solutions for employers and benefits brokers. HPI offers innovative health plan designs, including Consumer-Driven Health Plans (CDHP) and reference-based pricing, tailored to meet the unique needs of individual markets. With a commitment to providing advanced analytics and customized solutions, HPI aims to put employers in control of their healthcare costs while enhancing the member experience.

📋 Description

• Process claims in accordance with plan benefits. • Maintain minimum quality and production levels as determined by the Claims Manager. • Maintain updated filings for claim benefit investigation (medical necessity reviews, etc.) as required in accordance with plan benefits. • Prepare filings for outside vendors (subrogation) as required in accordance with the plan benefits. • Handle correspondence from Plan Correspondent and/or employees in a timely and efficient manner. • Resolve claim issues that do not require outside involvement. • Serve as back-up to Customer Service department, as needed. • Perform other various tasks that are deemed necessary and equitable by the Claims Manager

🎯 Requirements

• Ability to coordinate with management as effectively as with subordinates • Ability to prioritize and multi task effectively • Communicates effectively, both verbally and in writing • Ability to work both independently and as a member of the team • Ability to anticipate and understand systems interactions • Must be detailed, analytical and accurate • Recognize the need for follow-thru and follow-up • Ability to work within specified timeframe and meet deadlines • Recognize and maintain confidentiality of work materials as appropriate • High School diploma or combination of education, related experience or training • Prior claim processing experience desired • Knowledge of medical terminology and/or billing & coding preferred • Proficient with Microsoft Word and Excel or similar PC based programs

🏖️ Benefits

• Medical, Dental and Vision and Prescription Drug Coverage • Fitness Reimbursement Benefit • Employee Assistance Program • Flexible Spending Account & Health Savings Account • 401(k) and Quarterly Bonuses • Generous Paid-Time Off & Volunteering Opportunities • Educational Assistance & Professional Development Opportunities