[Remote] Claims Examiner II

Note: The job is a remote job and is open to candidates in USA. UST HealthProof is a trusted partner for health plans, offering integrated solutions for health plan operations. The Claims Examiner II is responsible for adjudicating healthcare claims, ensuring accuracy and compliance with client guidelines, while also mentoring junior team members and collaborating on special projects.

Responsibilities

• Be responsible for processing assigned claims based on client-specified guidelines or as directed by the team leader
• Be responsible for meeting productivity targets, financial and procedural accuracy standards as established by management
• Mentor junior members of the team
• Collaborate with other team members on special projects as assigned by the team leads; special projects can include process documentation development, training, quality audits, assisting with surge activity for the client(s), or any other project as determined by the team leader
• Knowledge base around physician practices and hospital coding, billing and medical terminology, CPT, HCPCS, and ICD-10, UB04, CMS 1500, authorizations, medical terminology, and concepts of healthcare
• Establish and maintain an appropriate level of communication with management to address issues and concerns and take preventive measures that ensure processing accuracy and quality

Skills

• Solid understanding and ability to analyze claim data
• High School degree required
• 1 - 3 years of healthcare claims processing experience
• Willingness to learn new skills
• Team collaborator
• Strong work ethic
• The ability to adapt quickly to a fast-paced environment
• A self-starter and quick learner
• Team player with an ability to collaborate
• ICD-10 CPT and HCPCS coding, is a plus

Benefits

• Full-time, regular employees accrue up to 16 days of paid vacation per year
• Receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year)
• 10 paid holidays
• Eligible for paid bereavement leave
• Eligible to participate in the Company’s 401(k) Retirement Plan with employer matching
• Eligible for medical, dental, and vision insurance
• Basic life insurance
• Accidental death and disability insurance
• Short- and long-term disability benefits
• May purchase additional voluntary short-term disability benefits
• Participate in a Health Savings Account (HSA)
• Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses
• Potential for quarterly incentive-based bonuses and or commissions depending on role

Company Overview

• UST HealthProof offers risk adjustment, quality programs, and healthcare payer technology services. It is a sub-organization of UST. It was founded in undefined, and is headquartered in Aliso Viejo, California, USA, with a workforce of 501-1000 employees. Its website is https://usthealthproof.com.

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