CLAIMS PROCESSOR
Department: Member Benefit Systems
Reports To: Claims Supervisor
Closing Date: Open Until Filled
Become a part of EMI Health’s growing organization. EMI Health is an employee benefits firm providing insurance products to companies and individuals in Utah, Arizona and Texas. We provide our employees with an outstanding benefit package that includes paid medical and dental coverage for employees, paid time off, holiday pay, vision, life, disability, HSA and retirement savings plans. In addition, we provide our employees with a fully equipped onsite fitness center and subsidize mass transit passes.
We are a tobacco free workplace, hiring non-tobacco users only.
EMI Health is an EEO employer as defined by the EEOC.
SUMMARY OF JOB: Under the direction of the Claims Supervisor, the Claims Processor resolves and adjudicates medical, dental and vision insurance claims. This is a full-time, non-exempt position. Hours are generally 8:00 a.m. to 5:00 p.m. Monday through Friday.
PRIMARY responsibilities:
Resolves exceptions and pends for medical, dental, and vision claims to a pay, pend, or deny status in a timely and accurate manner.
Reviews electronic and paper insurance claim forms and related documents for completeness.
Reviews claims information to determine the nature of a member’s illness or injury.
Determines and understands the coverage provided under a member’s plan to determine if claims are payable according to EMI Health’s guidelines, policies and procedures.
Exercises claim judgement within policy guidelines to make claim payment decisions to pay, request additional information or deny a claim.
Assists team members in support of achieving department and office goals.
Attends department meetings and training sessions.
EDUCATION, EXPERIENCE AND QUALIFICATIONS:
High school diploma or GED and at least two years of related experience and/or training; or equivalent combination of education and experience.
General knowledge of medical, dental, and vision terminology, coding, and health insurance benefit plans.
General knowledge of Medicare Secondary Payer and Coordination of Benefits rules, preferred.
