Brown And Brown
Location
Plano, TX | United States
Job description
Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers.
Health Special Risk, Inc. is seeking a Claims Examiner to join our team in Plano, TX. This position will be responsible for managing an assigned inventory consisting of K12 and Special Risk Accident Medical expense claims. This includes claims processing and adjudication as well as investigation when required. A work from home option is available with this position after the training period.
Health Special Risk, operating as a division of Brown & Brown Insurance, specializes in providing Accident & Health, Special Events insurance products, and administrative services to licensed agents, brokers, and insurance companies across the United States.
Health Special Risk offers a benefits and compensation package that meets today's most important needs and includes:
Competitive pay based on experience.
A challenging and stimulating career that provides growth and development.
Group medical, dental, vision, life, and disability benefits.
Paid time off and a 401(k) retirement plan as well as an Employee Stock Purchase Plan that allows our employees to purchase Brown & Brown stock at a discounted rate.
A chance to work for a smaller business and be recognized, while enjoying the stability and benefits of an S&P 500 company as a member company of Brown & Brown, Inc.
If you want to be part of a growing organization that is energetic and driven, contact us today.
JOB DUTIES :
Reviews claim with related documentation to determine if a claim is payable within policy provisions and limitations and requests additional information when needed.
Processes and adjudicates payable claims according to established procedures and within authorized payment limits or determine the basis for denial of benefits.
Identifies and routes claims for repricing or negotiation according to processing guidelines.
Ensures that all claims are handled in a timely manner to meet state-mandated requirements.
Follows-up on all suspends and referrals in a timely manner.
Achieves production-driven goals while maintaining the highest level of quality.
Other duties as assigned.
REQUIREMENTS :
High school diploma or equivalent and a minimum of three years previous claims processing/adjudication experience and/or an equivalent combination of education and experience.
In-depth knowledge and ability to read and interpret medical policies to determine claim eligibility.
Knowledge of CPT, HCPC ICD-10 codes.
Knowledge of HIPPA, pre-existing conditions, and coordination of benefits.
Procificient with MS Office Suite.
Strong detail-oriented and analytical skills.
Ability to make appropriate and sound decisions based on information provided.
Excellent written and verbal communication skills.
Ability to work independently under limited supervision.
Insurance knowledge/experience with medical terms and billing is preferred.
TriZetto QicLink or RIMS experience preferred.
For more information about Health Special Risk, please visit our website at .
We are an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants.
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