Hybrid Claims Examiner

JOB TITLE: Claims Examiner JOB LOCATION: Oniste 1 or 2 days a week in Irving TX WAGE RANGE*: $17hr to $18hr JOB NUMBER: 25-03140 REQUIRED EXPERIENCE: Looking for paralegal or Medicaid/Medicare experience Minimum 2-3 years experience Candidates must have strong attention to detail, ability to read fine print, research and make educated decisions. Strong computer skills, ability to switch between different programs (Microsoft tools, web browsing) JOB DESCRIPTION Summary Processes less complex or small standard claims to ensure accurate and timely completion.Enters insurance claims received electronically or in written form. Answers incoming customer calls regarding claim processing. Documents claim and associated history. Evaluates available information to validate straightforward basic claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility. Sends claim form to claimant for updating, correction or completion. Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment. Processes payment. Advises claimant of status and resolution of claim. Escalates claimant concerns as appropriate. Experience working with insurance and/or medical terminology Experience working with appropriate claims processing procedures and documentation Basic analytical and problem solving skills -Interpersonal skills to interact with team members Communication skills to communicate with customers -Data entry skills Ability to keep sensitive and confidential material private Ability to work in a team environment Work Environment Office environment Looking for paralegal or Medicaid/Medicare experience Minimum 2-3 years experience Candidates must have strong attention to detail, ability to read fine print, research and make educated decisions. Strong computer skills, ability to switch between different programs (Microsoft tools, web browsing) Equal opportunity employer as to all protected groups, including protected veterans and individuals with disabilities * While an hourly range is posted for this position, an eventual hourly rate is determined by a comprehensive salary analysis which considers multiple factors including but not limited to: job-related knowledge, skills and qualifications, education and experience as compared to others in the organization doing substantially similar work, if applicable, and market and business considerations. Benefits offered include medical, dental and vision benefits; dependent care flexible spending account; 401(k) plan; voluntary life/short term disability/whole life/term life/accident and critical illness coverage; employee assistance program; sick leave in accordance with regulation. Benefits may be subject to generally applicable eligibility, waiting period, contribution, and other requirements and conditions. Benefits offered are in accordance with applicable federal, state, and local laws and subject to change at TCM's discretion.