Claims Examiner-Product

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    "jobTitle": "Claims Examiner-Product",
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    "description": "<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><b><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">POSITION SUMMARY</span></span></b><br />\n<span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">The Claims Examiner is responsible for determining the proper payment (if any) of medical claims by group health plans, based upon specific knowledge and application of each client’s customized plan(s).</span></span><br />\n<br />\n<b><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">ESSENTIAL FUNCTIONS</span></span></b></span></span></p>\n\n<ul>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Independently review and analyze health care claims for: 1) reasonableness of cost; 2) medically unnecessary treatment by physicians and hospitals; and 3) fraud.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Determine whether a health plan provides benefits in connection with the claim submitted and the level of benefits to be paid to the provider.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Contact providers to negotiate discounts.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Log claims negotiated in Access database and create weekly summary reports.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Review and understand the terms and conditions of each clients’ customized plans.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Understand and comply with all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Request, review and analyze any physician notes, hospital records or police reports.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Consult with other entities who can offer additional evaluation of a claim.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Process claims in the QicLink System.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Review, analyze and add applicable notes to the QicLink System.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Document all information gathered in available systems as needed, including the QicLink System and alliedbenefit.com.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Review billed procedure and diagnosis codes on claims for billing irregularities.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Analyze claims for billing inconsistencies.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Review and analyze specific procedure and diagnosis codes for medical necessity.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Review Suspended Claim Reports and follow up on open issues.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Assist and support other team members as needed and when requested.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Attend continuing education classes as required, including but not limited to HIPAA training.</span></span></span></span></span></li>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">Other duties as assigned.</span></span></span></span></span></li>\n</ul>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><b><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">EDUCATION</span></span></b></span></span></p>\n\n<ul>\n\t<li><span style=\"font-size:12pt;\"><span><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">High School Diploma, College and Advanced Degrees Preferred or equivalent work experience required.</span></span></span></span></span></li>\n</ul>\n\n<p> </p>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><b><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">EXPERIENCE AND SKILLS</span></span></b></span></span></p>\n\n<p> </p>\n\n<ul style=\"margin-bottom:11px;\">\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Must have a minimum of 5 years of medical claims analysis experience (including dental and vision claims analysis).  </span></span></span></span></li>\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Strong analytical skills</span></span></span></span></li>\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Knowledge of computer systems and CPT and ICD-9 coding terminology.</span></span></span></span></li>\n\t<li style=\"margin-bottom:11px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Continuing education in all areas affecting group health and welfare plans is required.</span></span></span></span></li>\n</ul>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><b><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">POSITION COMPETENCIES</span></span></b></span></span></p>\n\n<p> </p>\n\n<ul style=\"margin-bottom:11px;\">\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Accountability</span></span></span></span></li>\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Analytical Thinking</span></span></span></span></li>\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Collaboration</span></span></span></span></li>\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Communication</span></span></span></span></li>\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Customer Focus</span></span></span></span></li>\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Functional Expertise</span></span></span></span></li>\n\t<li style=\"margin-bottom:11px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Initiative</span></span></span></span></li>\n</ul>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><b><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">PHYSICAL DEMANDS</span></span></b></span></span><br />\n </p>\n\n<ul>\n\t<li style=\"margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">This is standard desk role requiring extended periods of sitting and computer work.</span></span></span></span></li>\n</ul>\n\n<p> </p>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><b><span style=\"font-size:11pt;\"><span style=\"font-family:Arial, sans-serif;\">WORK ENVIRONMENT  </span></span></b></span></span><br />\n </p>\n\n<ul style=\"margin-bottom:11px;\">\n\t<li style=\"margin-bottom:11px;margin-left:8px;\"><span style=\"font-size:11pt;\"><span style=\"line-height:105%;\"><span style=\"font-family:Calibri, sans-serif;\"><span style=\"font-family:Arial, sans-serif;\">Remote</span></span></span></span></li>\n</ul>\n\n<p> </p>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:10.5pt;\"><span style=\"font-family:Arial, sans-serif;\">Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive</span></span><span style=\"font-size:10.5pt;\"><span style=\"font-family:Calibri, sans-serif;\">.</span></span></span></span></p>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:10.5pt;\"><span style=\"font-family:Arial, sans-serif;\">The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.</span></span></span></span></p>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:10.5pt;\"><span style=\"font-family:Arial, sans-serif;\">Compensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.</span></span></span></span></p>\n\n<p><span style=\"font-size:12pt;\"><span style=\"font-family:'Times New Roman', serif;\"><span style=\"font-size:10.5pt;\"><span style=\"font-family:Arial, sans-serif;\">Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.</span></span></span></span> </p>",
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Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.\\n\\nThe company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.\\n\\nCompensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.\\n\\nAllied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. Qualifications\",\"responsibilities\":\"POSITION SUMMARY\\nThe Claims Examiner is responsible for determining the proper payment (if any) of medical claims by group health plans, based upon specific knowledge and application of each client’s customized plan(s).\\n\\nESSENTIAL FUNCTIONS\\n\\n\\n\\tIndependently review and analyze health care claims for: 1) reasonableness of cost; 2) medically unnecessary treatment by physicians and hospitals; and 3) fraud.\\n\\tDetermine whether a health plan provides benefits in connection with the claim submitted and the level of benefits to be paid to the provider.\\n\\tContact providers to negotiate discounts.\\n\\tLog claims negotiated in Access database and create weekly summary reports.\\n\\tReview and understand the terms and conditions of each clients’ customized plans.\\n\\tUnderstand and comply with all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.\\n\\tRequest, review and analyze any physician notes, hospital records or police reports.\\n\\tConsult with other entities who can offer additional evaluation of a claim.\\n\\tProcess claims in the QicLink System.\\n\\tReview, analyze and add applicable notes to the QicLink System.\\n\\tDocument all information gathered in available systems as needed, including the QicLink System and alliedbenefit.com.\\n\\tReview billed procedure and diagnosis codes on claims for billing irregularities.\\n\\tAnalyze claims for billing inconsistencies.\\n\\tReview and analyze specific procedure and diagnosis codes for medical necessity.\\n\\tAuthorize payment, partial payment or denial of claim based upon individual investigation and analysis.\\n\\tReview Suspended Claim Reports and follow up on open issues.\\n\\tAssist and support other team members as needed and when requested.\\n\\tAttend continuing education classes as required, including but not limited to HIPAA training.\\n\\tOther duties as assigned.\\n\\n\\nEDUCATION\\n\\n\\n\\tHigh School Diploma, College and Advanced Degrees Preferred or equivalent work experience required.\\n\\n\\n \\n\\nEXPERIENCE AND SKILLS\\n\\n \\n\\n\\n\\tMust have a minimum of 5 years of medical claims analysis experience (including dental and vision claims analysis).  \\n\\tStrong analytical skills\\n\\tKnowledge of computer systems and CPT and ICD-9 coding terminology.\\n\\tContinuing education in all areas affecting group health and welfare plans is required.\\n\\n\\nPOSITION COMPETENCIES\\n\\n \\n\\n\\n\\tAccountability\\n\\tAnalytical Thinking\\n\\tCollaboration\\n\\tCommunication\\n\\tCustomer Focus\\n\\tFunctional Expertise\\n\\tInitiative\\n\\n\\nPHYSICAL DEMANDS\\n \\n\\n\\n\\tThis is standard desk role requiring extended periods of sitting and computer work.\\n\\n\\n \\n\\nWORK ENVIRONMENT  \\n \\n\\n\\n\\tRemote\\n\\n\\n \\n\\nHere at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.\\n\\nThe company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.\\n\\nCompensation is not limited to base salary.  Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.\\n\\nAllied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time.  All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process.  It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role. \",\"employmentType\":\"FULL_TIME\",\"hiringOrganization\":{\"@type\":\"Organization\",\"name\":\"Allied Benefit Systems\",\"logo\":\"https://www.paycomonline.net/v4/ats/web.php/application/style/logo?clientkey=518A90CE68B712867516B5A3986512DA\"},\"jobLocation\":{\"@type\":\"Place\",\"address\":{\"streetAddress\":\"200 WEST ADAMS ST\",\"addressLocality\":\"CHICAGO\",\"addressRegion\":\"IL\",\"postalCode\":60606,\"addressCountry\":\"USA\"}},\"industry\":\"Claims\",\"validThrough\":\"-0001-11-30\"}",
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