Health Plan Claims Examiner (OR)
Adventist Health · Portland, Oregon, US
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years....
Job description
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Reviews, evaluates and authorizes payment of medical, dental, vision, and prescription drug claims within the benefit descriptions and plan provisions of a variety of group plans. Determines the appropriate course of action on each claim (i.e., payment, further investigation, referral to review, denial, etc.). Responds verbally and in writing to claimants and providers regarding plan benefits and eligibility. Applies standard claims guidelines, such as coordination of benefits, workers' compensation and third-party investigations. Documents claims files regarding every verbal communication. Job Requirements: Education and Work Experience: - Associate's/Technical Degree or equivalent combination of education/related experience: Required...