Las Vegas, Nevada, United States · On-site
Primary Responsibilities Review and adjudicate claims submitted for reimbursement that fall outside auto adjudication standards on a daily basis, ensuring compliance with quality, productivity, and timeliness requirement…
Skills: Claims Adjudication, Medical Billing, Medical Terminology, Healthcare Contracts, Analytical Skills
Las Vegas, Nevada, United States · Hybrid
Primary Responsibilities: Process standard enrollment applications and eligibility updates for active, COBRA, retiree, and disability coverage in accordance with plan rules.Review, verify, and validate dependent document…
Skills: Enrollment Processing, Eligibility Verification, COBRA Administration, HIPAA Compliance, Dependent Documentation Review
Las Vegas, Nevada, United States · On-site
Primary Responsibilities: Process standard enrollment applications and eligibility updates for active, COBRA, retiree, and disability coverage in accordance with plan rules.Review, verify, and validate dependent document…
Skills: Enrollment Processing, Eligibility Verification, COBRA Administration, HIPAA Compliance, Dependent Documentation Review
Melville, New York, United States · On-site
About The Role MagnaCare is seeking a fully remote Customer Service Representatives to assist members, physicians, hospitals, and other healthcare providers with member benefits, eligibility, claims inquiry, claim recons…
Skills: Customer Service, Microsoft Office, CPT Codes, ICD-9, Problem Solving
Melville, New York, United States · On-site
*This is a Remote position. Key Responsibilities Apply medical policy, contractual provisions, and operational procedures to ensure accurate adjudication and/or adjustment of Group Health and Workers' Compensation Hospit…
Skills: Medical Claims Processing, Medical Terminology, CPT/HCPCS Coding, ICD Coding, Benefits Administration
Las Vegas, Nevada, United States · On-site
Primary Responsibilities Review and adjudicate claims submitted for reimbursement that fall outside auto adjudication standards on a daily basis, ensuring compliance with quality, productivity, and timeliness requirement…
Skills: Claims Adjudication, Medical Billing, Medical Terminology, Healthcare Contracts, Analytical Skills
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The Claims Examiner II is responsible for reviewing and adjudicating professional and facility claims while ensuring compliance with quality and timeliness standards. They also collaborate with internal teams and providers to resolve inquiries, perform claim adjustments, and manage account receivables.
Candidates must have at least one year of experience in medical billing or claims adjudication and possess strong knowledge of healthcare contracts and medical terminology. Proficiency in Microsoft Office and excellent communication skills are required to manage complex claim issues effectively.
Primary Responsibilities
Review and adjudicate claims submitted for reimbursement that fall outside auto adjudication standards on a daily basis, ensuring compliance with quality, productivity, and timeliness requirements.
Applying medical policies, contractual provisions, and operational procedures to ensure precise adjudication and adjustments.
Generate correspondence, such as letters and questionnaires, to gather additional information from customers and providers; may also initiate phone inquiries.
Collaborate with Customer Service to address and resolve customer inquiries and concerns effectively.
Research and resolve client inquiries and escalations in a timely manner, collaborating with internal teams as needed to ensure effective resolution.
Execute client-requested claim adjustments and provide clear, concise written responses to client inquiries within established deadlines.
Perform in-depth research on account receivables and spreadsheets that require claim adjustments, delivering thorough and clarifying responses to providers and clients.
Must be adaptable and willing to provide backup support across various departments and roles as needed
Responsible for processing all claim types including Professional and Facility claims
Perform Claim Adjustments as needed. Execute client-requested claim research and adjustments and provide clear, concise written responses to client inquiries within established deadlines
Essential Qualifications
Strong knowledge of healthcare contracts, medical terminology, and claims processing procedures.
Prior experience processing claims is required.
Minimum 1 year of experience in medical billing, claims adjudication, or a related role.
Excellent written and verbal communication skills, with the ability to manage inquiries professionally and efficiently.
Strong analytical skills with the ability to research and resolve complex claim issues.
Proficiency in Microsoft Office Suite, particularly Microsoft Word and Excel.
Ability to meet production and quality standards while managing multiple priorities.
Strong problem-solving skills and the ability to maintain professionalism under pressure.
The Nationwide TPA trusted for over 30 years
MagnaCare, a division of Brighton Health Plan Solutions, has been a leading and trusted Third Party Administrator for over 30 years. MagnaCare’s wide range of products and services meet the needs of Taft-Hartley Funds, employers, brokers, and other self-insured plan sponsors, TPAs, carriers, and workers’ compensation and no-fault payors. Through our deep discounts, innovative health care solutions, and uncommon flexibility, we help our customers control health care costs, improve health, and achieve exceptional value for their organizations and their members.
Offices: One Penn Plaza, 53rd Floor, NY, New York 10119, US · 1600 Stewart Avenue, Seventh Floor, Westbury, NY 11590, US · 2 Huntington Quadrangle, Suite 4N10, Melville, NY 11747, US · 44 West Gilbert Street, Tinton Falls, NJ 07701, US
The Nationwide TPA trusted for over 30 years
MagnaCare, a division of Brighton Health Plan Solutions, has been a leading and trusted Third Party Administrator for over 30 years. MagnaCare’s wide range of products and services meet the needs of Taft-Hartley Funds, employers, brokers, and other self-insured plan sponsors, TPAs, carriers, and workers’ compensation and no-fault payors. Through our deep discounts, innovative health care solutions, and uncommon flexibility, we help our customers control health care costs, improve health, and achieve exceptional value for their organizations and their members.
Offices: One Penn Plaza, 53rd Floor, NY, New York 10119, US · 1600 Stewart Avenue, Seventh Floor, Westbury, NY 11590, US · 2 Huntington Quadrangle, Suite 4N10, Melville, NY 11747, US · 44 West Gilbert Street, Tinton Falls, NJ 07701, US
