Claims Examiner – Lead

Job Description: • Manage daily operations of the Claims Examiner team • Assist with work distribution and individual performance tracking • Measure competency and production levels • Respond to technical questions from claims examiners • Assist the supervisor in implementing new processes and procedures • Perform auditing tasks • Provide training to internal users on plan benefit matrix and claims policies/procedures • Process claims and serve as a role model for staff • Evaluate complex medical, dental, and behavioral health claims • Provide excellent customer service to internal and external customers • Document all activities using CareOregon's on-line phone tracking system • Meet or exceed Department and Company policies including quality and production • Identify trends and communicate findings and process improvement ideas to the supervisor Requirements: • Minimum 3 years’ experience as a medical claims processor in the health insurance industry • Experience with people and/or project leadership • In-depth knowledge of claims adjudication principles and procedures • Advanced knowledge of CPT, HCPCS, Revenue, DPT and ICD-9 coding • Strong knowledge of medical, dental, mental health and health insurance terminology • Strong understanding of federal and state laws and other regulatory agency requirements that relate to the medical, dental, mental health and health insurance industry or Medicaid/Medicare industry Benefits: • Health insurance • 401(k) matching • Flexible spending account(s) • Employee assistance program • Wellness program • Discounts • Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings) • Strong retirement plan with employer contributions • Paid time off and Sick time • Paid holidays • Volunteer time • Jury duty • Bereavement leave Apply tot his job