Claim Examiner // Orlando FL 32822

Mindlance2

Orlando, FL, United States permanent

Posted: February 24, 2017

Job Description

Mindlance is a national recruiting company which partners with many of the leading employers across the country. Feel free to check us out at http://www.mindlance.com.

Business Claim Examiner

Visa GC/Citizen

Location 6272 Lee Vista Blvd, Orlando FL 32822

Division Pharmaceutical

Pay Negotiable

Contract 6 Month

Timings Mon - Fri between 8.00AM – 5.00PM

POSITION OVERVIEW

· Verify member submitted claims forms, member's eligibility & pharmacy information is complete & accurate, updating system information as needed.

· A high data entry proficiency is expected in order to provide accurate & timely processing of claims submitted by member, pharmacy or agencies.

· Moderate knowledge of drugs & drug terms used daily.

· Process claims according to client specific guidelines while identifying claims requiring exception.

· Navigate daily through several platforms to research & finalize claim submissions.

· Oral or written communication with internal departments, members, pharmacies or agencies to resolve claim issues.

· Adhere to strict HIPPA regulations especially when communicating to others outside of ESI.

· Prioritize & coordinate influx of daily workload for claims processing, returned mail & outgoing correspondence & e-mails to assure required turnaround time is met.

· Assess accuracy of system adjudication & alert management of potential problems affecting the integrity of claim processing.

· Analyze claims for potential fraud by member or pharmacy.

· May be required to work on special projects for claims team.

If you are available and interested then please reply me with your “Chronological Resume” and call me on (678)-405-3590.

Thanks & Regards,

Ranadheer Murari | Team Recruitment | Mindlance, Inc. | W: 678 405 3590

ranadheerm@mindlance .com

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