Claims Examiner

Overview

TITAN Insurance Administrators Inc. is a progressive third-party administrator of union health and welfare benefits, seeking an individual with a proven ability to multitask in a fast-paced environment. The individual must be dedicated, goal oriented, energetic, efficient and possess a strong work ethic. Bilingual Spanish skills are a plus.

We pride ourselves on our ability to adjudicate claims accurately and timely,

Claims Examiner – Job Description:

The candidate must be able to adjudicate medical, dental, disability and life insurance claims for active and retired Taft-Hartley Trust Fund participants in accordance with the benefit schedule and internal procedures. The candidate must also have the ability to process claims on-line timely and accurately, possess working knowledge of claims codes and descriptions, medical terminology, PPO provider adjudicating guidelines, Coordination of Benefits (COB), eligibility, limitations, exclusions, case management and medical review. Claims will be adjudicated using BASYS software in conjunction with the Anthem Blue Cross PPO claims system. This position requires a minimum of two (2) years of prior claims adjudicating experience.

Please note that this is a full-time position with union wages ($35-$38 per hour) and benefits.

Essential Job Functions:

The essential job functions include, but are not limited to the following:

1. Basic knowledge and understanding of group benefit plans.

2. Develop knowledge and understanding of TITAN’s (BASYS software) and Anthem Blue Cross PPO claims systems (WGS and B2).

3. Accurately interpret plan benefits and process claims accordingly.

4. Develop knowledge and understanding of PPO guidelines and procedures, COB, Medicare and supplemental plan benefits.

5. Customer Service Representative responsibilities answering eligibility and benefit questions, providing concise and accurate information, with a written synopsis of each call.

6. Communicate with providers and participants by phone, correspondence/email, faxes or in person.

7. Assist Auditors, Managers and other miscellaneous duties as assigned.

Requirements:

1. Minimum of two (2) years’ experience adjudicating medical, dental, disability and life insurance claims online.

2. Strong knowledge of medical terminology, standard coding and reference publications, including CPT, ICD-10, CMS Guidelines (HCPCS), HIPAA regulations and Health Care Reform requirements,

3. Ability to recalculate claims, performing (sometimes complex) calculations, applying formulas using multiplication and percentages.

4. Outstanding analytical skills, problem solving abilities, and organizational skills.

5. Ability to meet benchmark production requirements while maintaining high quality standards working individually and as a team contributor.

6. Excellent written and verbal communication skills.

7. Attention to detail and the ability to multi-task and work under pressure.

8. Ability to sit for extended periods of time, reach outward or above the shoulder, stand, walk, handle with fingers, stand, bend, and stoop.

9. Ability to operate a keyboard, view a video display terminal screen and documents, ability to use telephone equipment.

10. Ability to lift up to 10 pounds and push or pull up to 12 pounds.

To Apply:

• Please include the job title in the subject line of your email
• Resumes must be included as text or attached as a document
• Candidates who meet the required specifications will be contacted
• Please email resumes to rlosee@titan-tpa.com

TITAN Insurance Administrators, Inc. is an equal opportunity employer.

Job Type: Full-time

Pay: $35.00 - $38.00 per hour

Expected hours: 37.5 per week

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Work setting:

• In-person
• Office

Work Location: In person