Claims Examiner - REMOTE

S&S Health is a premier healthcare administration company located in Cincinnati, Ohio. We offer self, level, and fully funded solutions that lower costs while improving outcomes with a consumer-centric experience. Our integrated benefits, services, and technology platform have been developed to serve the needs of Employers, TPAs, and Health Systems. The company has a nationwide presence with the ability to sell and service in every state.

The Claims Examiner is responsible for the accurate and timely processing of medical claims and related correspondence. This role demands a high level of attention to detail, precision, and thoroughness. The Claims Examiner will work independently and collaboratively to adjudicate claims and respond to provider or client inquiries in a professional and timely manner.

Key Responsibilities:

• Accurately and promptly process claims and related correspondence.
• Gain and maintain an understanding of plan designs and apply that knowledge effectively.
• Process claims across all lines of business, including complex claims.
• Review claims for appropriate prior authorization/pre-certification of services.
• Review claims for required information and request additional details as needed.
• Handle adjustments and inquiries from Customer Service in a timely manner.
• Process third-party invoices efficiently.
• Multi-task effectively and meet deadlines consistently.
• Adhere to and maintain established quality and production standards.
• Work independently and cooperatively with other team members.
• Meet and maintain established performance metrics set by our customers.

Qualifications:

• Knowledge of medical terminology, HIPAA, standard claims forms (HCFA and UB), and physician billing coding.
• Ability to read and interpret contracts, and standard reference materials (PDR, CPT, ICD-9, ICD-10, and HCPCS).
• Knowledge of Coordination of Benefits (COB).
• Proficiency in Microsoft Word, Excel, and Outlook.
• High level of self-motivation, productivity, attention to detail, and organizational skills.
• Excellent verbal and written communication skills.

We are committed to creating a safe and secure workplace for all employees. Please note that all final candidates will be subject to a comprehensive background check and drug testing as part of our hiring process.