Jefferson Health · 7 hours ago
Claims Examiner - Jefferson Health Plan
Philadelphia, PA
Full-time
Onsite
Entry Level
2+ years expJefferson Health is a nationally ranked healthcare system dedicated to providing high-quality clinical care and education. The Claims Examiner role involves adjudicating medical claims in accordance with policies and procedures, ensuring accuracy, and maintaining performance standards.
Hospital & Health Care
Responsibilities
Able to work in a constant state of alertness and safe manner
Accurately adjudicates claims in compliance with data entry rules, On Line Processing Rules and contractual agreements
Reviews pended claims on a daily basis, assuring that all appropriate documentation is completed before adjudication
Accurately completes service forms for pended claims and routes to designated areas for resolution
Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes
Follow established procedures and guidelines for claims processing and high dollar claim review
Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy
Keeps current with Claims Department policies and procedures
Assist the unit in meeting and maintain performance standards
Qualification
Required
Able to work in a constant state of alertness and safe manner
Accurately adjudicates claims in compliance with data entry rules, On Line Processing Rules and contractual agreements
Reviews pended claims on a daily basis, assuring that all appropriate documentation is completed before adjudication
Accurately completes service forms for pended claims and routes to designated areas for resolution
Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes
Follow established procedures and guidelines for claims processing and high dollar claim review
Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy
Keeps current with Claims Department policies and procedures
Assist the unit in meeting and maintain performance standards
High School Diploma/GED
Ability to maintain strict confidentiality of patient information obtained in the performance of job function
Preferred
2 years claims processing experience or provider billing experience
Excellent communication skills required-both oral and written
Basic understanding of computer applications
General understanding of the principles of Managed Care
Benefits
Medical (including prescription)
Supplemental insurance
Dental
Vision
Life and AD&D insurance
Short- and long-term disability
Flexible spending accounts
Retirement plans
Tuition assistance
Voluntary benefits
Access to group rates on insurance and discounts
Tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service
Access to medical (including prescription) insurance
Company
Jefferson Health
Thomas Jefferson University and Thomas Jefferson University Hospitals are partners in providing excellent clinical and compassionate care for our patients in the Philadelphia region, educating the health professionals of tomorrow in a variety of disciplines and discovering new knowledge that will define the future of clinical care.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
ANTHONY S. NAH, Jr., B.S., MSc.
President / CEO
Ron Kumor
President/ CEO Aria Jefferson Health Physician Services and Senior Vice President, Network Dev
Recent News
Philadelphia Business Journal
2025-03-26
2024-04-29
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