CBsalary.com Home » Salary Calculator » Salary Search Results for Medical Claims Examiners

Search Results

Review settled claims to determine that payments and settlements have been made in accordance with company practices and procedures, ensuring that proper methods have been followed. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.

Director Educational Board of Nurse Examiners

Directs activities concerned with maintaining educational standards established by board of nursing or other legally authorized agency: participates in development and implementation of philosophy, purpose, policies, and plans of board of agency, and consults with and advises administrators of nursing schools in regard to curricula and facilities for instruction. Plans and conducts surveys of nursing schools and advises institutions desiring to establish schools on policies and procedures. Maintains current and comprehensive records and reports and keeps informed on trends and developments within the profession. May assist with administrative functions.

Claims Administration Director

Oversees and directs the management of the claims function to include review and approval of claims. Directs the implementation and ongoing maintenance of claims handling systems, policies, and procedures. Typically requires a college degree and five or more years of claims management experience.: Monitors departmental operations to ensure compliance with regulatory agencies as well as contractual obligations. Performs regular data analysis of claims payment reports to identify variances so that areas of focus may be identified and resources may be appropriately deployed. Provides support on complex claims issues. Prepares and manages the departmental budget and manages expenses. Hires, develops, and motivates a qualified claims processing staff.

Medical Claims Review Manager

Manages the medical claims review staff to ensure process improvement and quality in claims review. This position typically requires a Bachelor’s degree with five years of medical review experience. This position may require a nursing degree.: Manages the medical claims review staff to ensure process improvement and quality in claims review. Translates benefit plan language (Summary Plan Descriptions) into standard review program procedures. Interfaces with clients to conduct/manage random sample reviews to determine medical claims processing accuracy and timeliness. Works with clients to coordinate operational reviews to assess administrative processes and controls. Reviews company claims, eligibility, provider, and medical management systems to identify issues affecting quality and productivity. Documents findings and write follow-up reports. Provides planning, organizing and budgeting for the department. Develops, administers and reports service quality indicators for each team under supervision. Recommends and implements innovative strategies to retain members, contain medical costs and improve efficiency. Hires, trains, coaches, counsels and evaluates performance of direct reports. This position typically requires a Bachelor’s degree with five years of medical review experience. This position may require a nursing degree.

Medicare Claims Supervisor

Supervises the Medicare claims processing staff to ensure accurate and timely adjudication of claims. This position typically requires four years of experience in claims processing or auditing.: Supervises the Medicare claims processing staff to ensure accurate and timely adjudication of claims. Provides training and development, communicates policies and procedures, and monitors work production quantity and quality. Reviews and resolves complex claims issues that cannot be resolved by subordinates and releases high dollar claims as needed. Ensures that all claims are processed according to the terms of the plan contract and applicable policies, procedures and department guidelines. Oversees documentation of claims and billing forms to support claim decision, payment or denial. In addition to supervisory skills, must have knowledge of discipline equal to or exceeding that of direct reports. Typically supervises more than 8 Claims Adjudicators. Tracks and monitors claims volume and age of inventory. Submits statement of claim liabilities to accounting for review. Interprets company policy to employees and enforces company policy and practices. Reviews and analyzes processes, procedures and workflows to identify opportunities for process improvement and efficiency. Prepares regular periodic reports and reviews/monitors system reports to ensure adherence to corporate and regulatory standards within established guidelines. Monitors the work flow process to ensure that work is distributed appropriately. This position typically requires four years of experience in claims processing or auditing. May be called upon to manage unit(s) in the absence of the Claims Manager. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action.

Claims Supervisor

Supervises and coordinates activities of workers engaged in examining insurance claims for payment in claims division of insurance company. Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications. A bachelor's degree with four years of claims examining/auditing experience may be required to fulfill the requirements of this position.: Ensures evaluation of all claims through determination of types and amounts of benefit payable. Ensures/oversees documenting of provider claims/billing forms to support payment/decisions. Ensures claims processing is consistent with applicable policies, procedures, and department guidelines. Supervises maintenance of claims records. Reviews appeals and complaints that Examiners are unable to resolve. Analyzes and approves insurance claims. Conducts personal interviews with claimants to explain procedure for filing claims. Submits statement of claim liabilities to actuarial department for review. Informs departmental supervisors on claims status. Interprets company policy to employees and enforces company policy and practices. Reviews and analyzes processes, procedures, and workflows to identify opportunities for process improvement and efficiency. Prepares regular periodic reports, and reviews/monitors system reports to ensure adherence to corporate and regulatory standards within established guidelines. May participate in the specialized training and handling of complex claim situations and projects requiring advanced claim knowledge and experience, as delegated by Claims Manager and/or Director. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action.

Medical Claims Review Nurse

Resolves, audits, and processes claims for clinically related issues to ensure accuracy of claims payment, supporting the Claims Administration Department. Maintains contact with community hospitals and providers, reviewing, processing, and auditing claims for payment and appropriateness of charges and pursues adjustments as warranted. Typically requires licensure as a Registered Nurse and at least one year of experience in utilization review or a managed care setting.: Screens, audits, and processes claims of specific criteria for appropriate payment. Establishes effective ongoing relationships with community hospitals and providers. Participates in educational, provider relations, and contracting meetings with providers to address medical claims payment issues. Visits the providers as necessary to compare billed charges to the medical record. Provides support to the Accounting Department in determining financial liability for out-of-plan medical services. Performs special projects, reconciliations, research, and analysis relating to the utilization and cost of medical services. Works closely with various departments to coordinate the flow of information involving payment of medical bills and analyses of financial liability. Ensures compliance with contractual obligations on claims payments. Documents findings and writes follow-up reports. Recommends and implements innovative strategies to retain members, contain medical costs, and improve efficiency.

Claims Auditor

Conducts claims audits to ensure accuracy of claims determinations. Manages and coordinates the reporting, review, and maintenance of data for use in supporting audit functions. : Performs claims audits based on audit program and specified target audits as assigned. Documents audit findings accurately. Assures quality of claim determinations and ensures compliance with regulations and plan requirements. Researches, analyzes, and understands claims processing and payment regulations. Understands and applies standard pricing methodologies for claims. Identifies underpayments/overpayments and generates reports to quantify amounts detected through audit process. Communicates errors to Production Manager or Supervisor and trends errors for corrective actions. Identifies and develops potential areas for claim audits. Evaluates audit initiatives and identifies enhancements to the audit processes and procedures as needed. Determines whether to accept, reject, or request additional information based on policies and procedures.

Insurance Benefits Claims Processor

Adjudicates benefit claims and processes claims for payment. Analyzes and answers inquiries regarding claim adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Requests all information from internal or outside sources to ascertain completeness and validity of claim including coordination of benefits information. : Compares data on claim application, death certificate, or physician's statement with policy file and other company records to ascertain validity and to adjudicate the claim. Analyzes claims to determine extent of liability and settles claims with claimants in accordance with policy provisions. Researches claim as needed. Corresponds with agents and claimants, or interviews them in person to correct errors or omissions on claim forms and to investigate questionable entries. Pays claimant amount due. May investigate claims in field.

Insurance Claims Adjuster

Investigates claims against insurance or other companies for personal, casualty, or property loss or damages; determines extent of company's liability and attempts to effect out-of-court settlement with claimant. Most organizations prefer college graduates for entry into this job.: Examines claim form and other records to determine insurance coverage. Interviews, telephones, or corresponds with claimant and witnesses; consults police and hospital records; and inspects property damage to determine extent of company's liability, varying method of investigation according to type of insurance. When a policy holder's claim is legitimate, the claims adjustor negotiates with claimant and settles the claim. When claims are contested, adjustors may testify in court. Recommends litigation by legal department when settlement cannot be negotiated. May consult with other professionals who can offer more expert evaluation of a claim. May attend litigation hearings.

Search Again

1 2 3 Next

Search Jobs by Salary Range

Job Openings

Based on your search criteria, you may be interested in the following jobs

- Claims Examiner / Medical and Dental Claims
We are currently seeking Claims Examiners working with medical and dental claims to join our...review, process and/or adjust medical, dental or...

- Medical Claims Examiner
Medical Claims Examiner CB309216 Naperville By Mail APEX HEALTHCARE - With experience in the insurance claim process/review, Medicare payment rules,...

- Medical Claims Examiner
Medical Claims examiner needed for an insurance company in the San Fernando Valley . Candidate must know EZ Cap, have extensive knowledge of PPO's and...

- Insurance Claims Examiner
Insurance-F/T or P/T Claims Examiner Local Management Service Organization seeking an experienced Claim Examiner. Candidate requirements: Must......

- Healthcare Claims Examiner (24846)
...looking for 20+ Claims Examiners to join our team...Responsibilities: The Claims Examiner provides operational...Experience with medical health...

Negotiating Salary? Would a Degree Help?

Employment Spot

Navigation