Company: AmeriHealth Caritas Health Plan
Posted on: January 27, 2023
This position offers $1500 Sign-on Bonus for external
The Claims Examiner reports to the Supervisor of Claims.The Claims
Examiner is responsible for reviewing and adjudicating claims based
on provider and health plan contractual agreements and claims
- Complies with all internal processes and procedures to ensure
activities are handled in accordance with departmental and company
policies and procedures.
- Review, research, analyze, and process complex healthcare
claims by navigating multiple computer systems and platforms and
accurately capturing the data/information for processing (e.g.
verify pricing, prior authorizations, applicable benefits).
- Escalates claim and/or system issues to Team Lead or
- Creates and supports a professional environment which fosters
teamwork, cooperation, respect and diversity.
- Meet department quality and production requirements
- This position is required to meet and maintain performance
goals established for the position in the areas of quality and
- Process claims for multiple Lines of Business as requested by
- Understands processing rules for multiple lines of business and
supports other lines of business as needed to meet business
- High School/GED required
- Associate's Degree preferred
- One to three years prior claims experience preferred
- Mathematical aptitude and analytical skills
- Demonstrated ability in using computer and Windows PC
applications, which includes strong keyboard and navigation skills
and leaning new computer programs.
- Ability to research and investigate information using multiple
sources and documented guidelines
- Strong interpersonal skills
- Excellent listening, verbal and written communications
- Excellent comprehension, reasoning and decision making
Keywords: AmeriHealth Caritas Health Plan, Philadelphia , Claims Examiner, Other , Philadelphia, Pennsylvania
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