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Claims Examiner

Rochester, Minnesota 55901

Job ID: 9302 Category: Professional

Job Description

  • The position has direct report to the Operations Supervisor and works cooperatively with Manager and Director of
  • Operations and allied health staff within our Client's Health Solutions and our Client’s Medical Center.
  • Works collaboratively with our Client's Health Solutions Supervisors, Account Managers, Business Analysts and staff in all areas of our Client’s Health Solutions TPA Services. Serves as a resource to Network Development, Membership,
  • Credentialing, Health Services, Finance and Customer Service staff. Interacts with other areas and our Client’s departments, i.e., our Client’s Patient Account Services, Patient Financial Services, Recovery and Claims Services and other
  • Externally interacts with physicians/providers offices and leased network administrators.
  • Responsible for ensuring high quality claims adjudication for customers while meeting our Client’s Health Solutions goals for production standards, accuracy and claims turnaround time.
  • The position is directly responsible to adjudicate claims accurately and on a timely basis.
  • Troubleshooting system and process-related issues as well as participate in quality assurance and continuous improvement initiatives to better service our Client’s customers.


Specific Job Details:

  • Shift: 8-5, M-F.
  • Will be required to be onsite for 2 weeks for training.
  • Will need to use their own computer/equipment - manager prefers they have a dual monitor to assist with productivity.



  • Requires an Associate's degree or the equivalent amount of education towards a Bachelor's degree.
  • Two years' experience in business or the healthcare industry OR 3 years direct experience in medical claims adjudication OR 5 years medical claims billing. In addition, the job requires the following skills: demonstrated analytical and problem solving skills;
  • Experience with windows based software systems; strong typing skills, data entry speed and 10-key stroke capability with high percent of accuracy; ability to cope with varied levels of workload and multiple tasks;
  • Understanding and acceptance of the team concept; excellent organizational and listening skills; strong human relations skills to interact with customers; and the ability to work well under pressure.
  • Must be able to work and self-manage in a fast paced changing environment while making independent decisions.
  • Claims processing experience, knowledge of medical terminology, health insurance industry terminology, and CPT-4, CDT, ICD-9 and HCPCS's procedure and diagnosis coding preferred.
  • Ability to work in a production-oriented environment.
  • Certification in one of the following would be beneficial;
  • Registered Health Information Technician (RHIT);
  • Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist -
  • Physician based (CCS-P), or Certified Professional Coder (CPC) credentials.
  • Bachelor's degree preferred.
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