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CareOregon logo
CareOregon

CareOregon is a nonprofit organization that reforms health plan services, and has been doing so since 1994. The organization serves Oregon Health Plan Medicare

Claims Examiner II

Location

Oregon

Posted

91 days ago

Salary

$22 - $27 / hour

Seniority

Mid Level

Associate Degree2 yrs expEnglish

Job Description

Claims Examiner II

CareOregon

• Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and CareOregon policies and procedures • Re-adjudicate, adjust or correct claims, including some complex and difficult claims as needed • Consistently meet or exceed the quality and production standards established by the department and CareOregon • Provide excellent customer service to internal and external customers • Collaborate and share information with Claims teams and other CareOregon departments to achieve excellent customer service and support organizational goals • Determine eligibility, benefit levels and coordination of benefits with other carriers; recognize and escalate complex issues to the Lead or Supervisor as needed

Job Requirements

  • Minimum 2 years’ experience as a Medical Claims Examiner or other role that requires knowledge of medical coding and terminology (e.g., medical billing, prior authorizations, appeals and grievances, health insurance customer service, etc.)
  • Preferred Experience using QNXT, Facets, Epic systems
  • Knowledge of CPT, HCPCS, Revenue, CDT and ICD-10 coding
  • Knowledge of medical, dental, mental health and health insurance terminology
  • Ability to perform fast and accurate data entry
  • Basic computer skills (ability to use Microsoft Outlook, Word and Excel) and learn new systems as needed

Benefits

  • medical, dental, vision, life, AD&D, and disability insurance
  • health savings account
  • flexible spending account(s)
  • lifestyle spending account
  • employee assistance program
  • wellness program
  • discounts
  • multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
  • strong retirement plan with employer contributions
  • benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state
  • paid holidays
  • volunteer time
  • jury duty
  • bereavement leave

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Job Closed