Claims Examiner

Aps Health Care Pr is seeking a skilled Claims Analyst to join our team. As a Claims Analyst, you will be responsible for processing claims in accordance with established policies and procedures.

• Process claims utilizing data entry and adjudication, and execute claims' adjustments when needed.
• Maintain a thorough knowledge of provider contractual issues and summarize plan documents for each assigned account.
• Identify possible coordination of benefits (COB) coverage if applicable.
• Follow claim processing guidelines to obtain all necessary information for accurate and timely processing.
• Process routine claims adjustments either electronically or manually while maintaining daily productivity rating.
• Collaborate with duties related to the claim audit process, including claim analysis, site visits, document preparation, and proper file storage.
• Maintain overall quality, accuracy of financial, and procedure aspects of operation.
• Receive and process correspondence when needed.
• Collaborate with new hire training when needed.

• High School diploma.
• Degree in Data Entry or related preferred.
• Minimum 1 year of experience in a similar position or data entry.
• Knowledge of Microsoft Office, including Excel, Word, and PowerPoint.
• Knowledge of general claim processing.
• Knowledge of Medical terminology, CPT, and DSMV coding.
• Strong verbal and written communication skills.
• Strong analytical skills with demonstrated ability to problem solve.
• Consultative selling skills and experience with ability to translate customer needs to sales opportunities.
• Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas.
• Organizational skills with the ability to handle multiple tasks and/or projects at one time.
• Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time.
• Problem solving skills with the ability to look for root causes and implement workable solutions.
• Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs.