Health Plan Claims Examiner

Adventist Health is seeking a Health Plan Claims Examiner to review, process, and authorize payments for medical, dental, vision, and prescription drug claims. This role involves working with a computerized claims payment system, utilizing coding standards, and ensuring accuracy in claims documentation. The position is critical for managing healthcare benefits and maintaining operational efficiency.

Requirements

• Process medical, dental, vision, and prescription drug claims.
• Determine claim course of action (payment, investigation, denial, etc.).
• Coordinate benefits with primary carriers and utilize Utilization Review when required.
• Researches and documents rejected or erroneous claims.
• Handles incoming calls and maintains productivity standards.