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Job Details

« Back to Search Medical Claims Examiner
Fresno, CA

Date Posted: March 25, 2019
Job Type: Direct Hire
Job ID: 352336

Job Description

Are you looking for a fresh and innovative company to apply your medical claims examiner skills in Fresno?  Do you have what it takes to take a strong up and coming TPA to the next level?  Do you love what you do and want to grow with an amazing organization?  If this describes you we just might have what you are looking for. 

Our client in Fresno is looking for an experienced and meticulous Medical Claims Examiner to join their prolific team.  This particular client is growing at a very fast pace and wants nothing but the best.  If you fit the bill and would like to know more, reach out to us at Insurance Relief!

Medical Claims Examiner Duties and Responsibilities

  • Determines covered medical losses by studying provisions
  • Studying medical documentation and establishing proof; as required assembling additional information from outside sources, including physician, claimant, hospital, employer, and other insurance outfits; investigating questionable claims.
  • Documents claims actions by reports, logs, completing forms, and records.
  • Resolves medical claims by approving or denying documentation; initiating payment or composing denial letter; calculating benefit due.
  • Follow company policies, procedures, guidelines, as well as state and federal insurance regulations.
  • Maintains strong customer service and responding to customer inquiries.
  • Assembling documentation for settlement action and legal support.
  • Keeping claims information confidential.
  • Prepares reports by analyzing, collecting, and summarizing information.
  • Constantly updating job knowledge by participating in educational opportunities; maintaining personal networks; reading professional publications and participating in professional organizations.
  • Accomplishes organizational goals by accepting ownership for accomplishing new and different requests.

Medical Claims Examiner Skills and Qualifications

  • Claims Adjustment
  • Analyzing Information  
  • Problem Solving
  • Verbal Communication 
  • Customer Focus
  • General Math Skills
  • Statistical Analysis
  • Financial Software
  • Documentation Skills
  • Data Entry Skills