Claims Examiner

🔥 3 hours ago

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Point C

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

📋 Compliance

🤝 B2B

Healthcare Insurance • Compliance • B2B

Point C is a trusted health benefits partner that delivers meaningful solutions for brokers and their self-funded clients. The company specializes in administering benefit plans, managing medical costs effectively, and ensuring a high-value experience for members. With a focus on vendor integration and data-driven insights, Point C aims to simplify the benefit process while providing access to quality care and innovative mobile tools for its clients and their employees.

📋 Description

• Adjudicate new claims and process adjustments, including denials upon receipt of additional information • Review and resolve appeals and subrogation/third-party liability cases • Manage individual inventory to ensure timely turnaround and production goals are met • Ensure claims are processed in accordance with stop loss contract terms • Respond to internal and external inquiries via email and other channels within established timeframes • Follow up on missing or incomplete information to ensure claims can be accurately processed • Maintain minimum production, financial, and procedural accuracy standards on a monthly basis

🎯 Requirements

• Experience with Third Party Administrator (TPA) or self-funded claims administration preferred • At least 2+ years of experience in insurance claims processing required • Experience reviewing and finalizing claim payments for accuracy in accordance with plan policies • Ability to interpret and apply plan documents to ensure accurate claims adjudication • Demonstrated understanding of both claim review processes and underlying benefit plan design • Experience with HealthPac, El Dorado, Javelina, or VBA systems preferred • Working knowledge of CPT and ICD-10 coding • Basic understanding of medical terminology • Strong communication and customer service skills • Proficiency in Microsoft Office and general computer applications • Ability to maintain confidentiality and comply with all company policies and procedures • Able to work independently with minimal supervision • Ability to prioritize, multitask, and work overtime as needed • Associate Degree Preferred

🏖️ Benefits

• Comprehensive medical, dental, vision, and life insurance coverage • 401(k) retirement plan with employer match • Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) • Paid time off (PTO) and disability leave • Employee Assistance Program (EAP)