Harris Computer ยท 1 day ago
Claims Examiner
Tennessee, United States
Full-time
Onsite
Entry, Mid LevelHarris Computer is a company focused on providing effective solutions in claims processing. They are seeking a Claims Examiner to evaluate incoming claims for eligibility and coverage, communicate with stakeholders about claim status, and ensure compliance with regulatory requirements.
Computer Software
Responsibilities
Evaluate incoming claims to determine eligibility, coverage, and validity
Conduct thorough investigations, including reviewing medical records and other relevant documentation
Analyze policy provisions and contractual agreements to assess claim validity
Utilize claims management systems to document findings and process claims efficiently
Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements
Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process
Address customer concerns and escalate complex issues to senior claims personnel or management as needed
Ensure compliance with company policies, procedures, and regulatory requirements
Maintain accurate records and documentation related to claims activities
Follow established guidelines for claims adjudication and payment authorization
Identify opportunities for process improvement and efficiency within the claims department
Participate in quality assurance initiatives to uphold service standards and improve claim handling practices
Collaborate with team members and management to implement best practices and enhance overall departmental performance
Generate reports and provide data analysis on claims trends, processing times, and outcomes
Contribute to the development of management reports and presentations regarding claims operations
Qualification
Required
Evaluate incoming claims to determine eligibility, coverage, and validity
Conduct thorough investigations, including reviewing medical records and other relevant documentation
Analyze policy provisions and contractual agreements to assess claim validity
Utilize claims management systems to document findings and process claims efficiently
Communicate effectively with policyholders, beneficiaries, and healthcare providers regarding claim status and requirements
Provide timely responses to inquiries and maintain professional and empathetic communication throughout the claims process
Address customer concerns and escalate complex issues to senior claims personnel or management as needed
Ensure compliance with company policies, procedures, and regulatory requirements
Maintain accurate records and documentation related to claims activities
Follow established guidelines for claims adjudication and payment authorization
Identify opportunities for process improvement and efficiency within the claims department
Participate in quality assurance initiatives to uphold service standards and improve claim handling practices
Collaborate with team members and management to implement best practices and enhance overall departmental performance
Generate reports and provide data analysis on claims trends, processing times, and outcomes
Contribute to the development of management reports and presentations regarding claims operations
Company
Harris Computer
Harris provides mission-critical software solutions for the Public Sector, Healthcare, Utilities, and Private Sector verticals throughout North America, Europe, Asia, and Australia.
Founded in 1976
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Scott Thomas
Group Leader/CEO - Novum Group, Harris Healthcare (Constellation Software TSX:CSU)
Diane Gibson, SHRM-CP
Human Resources Business Partner
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