Claims Examiner III
Doctors HealthCare Plans, Inc.2 days ago
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OnsiteFull-timeEntry
Summary
Doctors HealthCare Plans, Inc. is seeking a Claims Examiner III to join their team in Coral Gables, FL. The role involves ensuring claims are processed according to department standards and assisting the Claims manager in maintaining workflow and processes.
About the Role
As a Claims Examiner III, you will review and release professional and institutional claims, process Member Reimbursement claims, and coordinate with the Assistant Director on workflow issues. You will assist in generating reports to track productivity, collaborate on policy application, and ensure the team meets production and quality metrics. Additionally, you will maintain a positive environment that supports staff well-being and fosters teamwork.
About You
Required:
- High School Diploma or GED
- 3+ years as Medical Claims Examiner
- Experience in contract interpretation
- Knowledge of CMS guidelines and regulations
- Ability to work with Windows and other computer applications
- Ability to work well with others
Doctors HealthCare Plans, Inc.
Welcome to Doctors HealthCare Plans! Doctors HealthCare Plans, Inc., is a Florida-based, locally owned health plan providing coverage in Miami-Dade and Broward Counties and specializing in Medicare. We have an extensive list of participating providers, hospitals and pharmacies. Whether you are a Doctors HealthCare Plans member or provider, all inquiries and requests are addressed by a friendly and local Team.
Coral Gables, FL