Claims Examiner - The Health Plan

 
Position: Claims Examiner - The Health Plan

Job ID: 148647

Location: US-TX-Bellaire

Department: Claims - Examination

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a -5p Monday - Friday

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for a Claims Examiner – someone who works well in a fast-paced setting. In this position, you’ll process and adjudicate claims received for reimbursement to providers based on the extensive review, research and a detailed format of claim processing procedures. Additionally, you’ll make routine decisions including claims adjudication within the appropriate levels of authority.

 

Think you’ve got what it takes?



Responsibilities :

  • Adjudicate claims received into the processing system
  • Thoroughly review, investigate and adjudicate claims daily
  • Process claims accurately as defined by standard guidelines
  • Special projects as requested
  • Process a minimum of 14 claims per hour, or a minimum of 98 claims per day
  • Conduct reviews and investigations of pended claims and follow up with internal and external departments to finalize claims
  • Access requests are processed within 30 days of receipt
  • Ensures timely resolution of claims, in adherence to HHSC regulatory requirements


Qualifications:

  • High school diploma or GED
  • One year of claims examination experience


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