The Senior Claims Review staff member is responsible for managing high dollar and complex health claims for a variety of individual products. This position is highly technical and must have an in depth knowledge of claims management within policy language constraints. This position is also responsible for managing a group of 3 or 4 highly experienced senior claims examiners. Position must coordinate and communicate with other managers within the Claim Department. Regularly interacts with management of other company departments to maintain good communications within the Company. Interprets policy contract language and accurately determines complex and high dollar medical benefits, using knowledge of ICD, CPT and HCPC codes. Position requires an understanding of state and federal guidelines including the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act.
10 to 15 years of experience managing complex and high dollar health claims preferably for an individual insurance carrier
Strong verbal and written communication skills
Attention to detail and strong organizational skills
Knowledge of insurance and medical terminology is required
Must be self-motivated, stress and pressure resistant, quick learner
Additional Salary Information: Benefits include medical benefits, 401K and paid vacations.