Claims Examiner Lead

What you'll be doing: Appropriately and correctly evaluate complex and difficult medical, dental, and mental health claim which may result in adjudication, re-adjudication or adjustments of claims in accordance and/or compliance with plan provisions, state/federal regulations, and company policies/procedures. Provide excellent customer service to internal and external customers based on department and company standards. Utilize company on-line phone tracking system to document all activities from any mode of communication as defined by company and claim department policies. Consistently meet or exceed department and company policies including but not limited to quality, production, attendance, conduct. Make determinations of eligibility, benefit levels, coordination of benefits with other carriers, recognize and investigate third party issues which may require working with attorneys or outside agents. Assist the claims supervisor in mentoring new or existing claims examiners which includes auditing employee work, identifying ways in which quality and productivity can be improved, and adjustments can be minimized. Assist claims examiners with claims processing and other questions. Demonstrate initiative in seeking and understanding needed information about policies and procedures. Proactively work to build and improve the team. Perform other duties and projects as assigned.

Who is the client company: This is a nonprofit organization committed to improving and protecting the health of low income and vulnerable Oregonians (Medicare and Medicaid).; If you are interested in this position, send your resume to apply@kochdavis.com