Claims Examiner

Job description

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the most vulnerable senior population, while serving as a care provider and care plan to those individuals we serve. Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Examiner plays a pivotal role in ensuring timely and efficient processing of claims for our contracted specialty provider partners. Essential Job Duties: - Examine, review and process claims according to contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards - Assess appropriateness of returned, denied, or paid claims by reviewing and following contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards - Ensure claim timeliness processing standards are being met - Work alongside manager to establish and maintain claims processing rules that meet all regulatory and business requirements - Assist internal and external partners with questions related to claims decisions or claims statuses - Maintain a c...