Medical Claims Examiner

3 weeks ago


Shrewsbury, Shropshire, United Kingdom University of Massachusetts Medical School Full time
About the Role

As a Medical Claims Examiner at the University of Massachusetts Medical School, you will play a crucial role in ensuring the timely processing of professional and facility medical services claims. This position requires attention to detail, excellent analytical skills, and the ability to work independently in a fast-paced environment.

The successful candidate will be responsible for reviewing and inputting data into the claims payment system using standard policies, procedures, and guidelines. They will also interpret plan contract language and apply appropriate benefit coverages based on the plan provisions with high quality while meeting production standards as defined by management.

In this role, you will work closely with various functions such as finance, contracting, and operations to ensure lines of communication are kept open with processing or auditing related issues. You will also build productive working relationships internally and externally.

Key Responsibilities
  • Review and input data into the claims payment system
  • Interpret plan contract language and apply benefit coverages
  • Work closely with finance, contracting, and operations teams
  • Build productive working relationships internally and externally
Requirements

This role requires a Bachelor's Degree in a related field or commensurate years of experience in a directly related field. The ideal candidate will have 3-5 years of claims processing experience and a minimum of 2 years of claims quality assurance experience.

You must be able to read and interpret documents such as processing and procedure manuals, medical terminology, and claims rules and regulations to appropriately adjudicate claims. Excellent analytical and problem-solving skills are essential for success in this role.



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