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Claims Examiner

Location : Garden City, NY
Job Type : Temp/Contract
Hours : Full Time
Travel : No
Relocation : No

Job Description :
• The Claims Specialist sets adequate reserves to ensure proper reporting.
• Compares data on claim form with insurance plan to ascertain completeness and validity of the claim.
• Examines claim form and other records to determine insurance coverage.
• Proactively works to resolve claim as expeditiously as possible.
• Reviews and analyze detailed medical records.
• Calculates reimbursement of benefits according to the schedule of coverage. Runs various claim reports as directed by the account.
• Liaison with Marketing/Customer Service departments.
• Cultivates relationships.
• Incrementally increase productivity without jeopardizing quality.
• Approves claims at the appropriately demonstrated assigned authority level.
• Functions as a resource for examiners and assist with training new examiners and customer service representative.
• Handles difficult phone calls and composes special correspondence.



Required Qualifications :
• 1 – 3 years CLAIMS ADJUDICATION experience
• Writes clearly, concisely and effectively.
• Communicates verbally effectively and with impact.
• Computer literate.
• Detail oriented
• Ability to multi-task and mange time effectively


Education:
High School or GED required. College preferred, or equivalent work experience
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