Claims Examiner I - BPA

Claims Examiner I Smart Data Solutions, a leading provider of data management, claim routing and workflow solutions to health plans and TPAs, is looking for a Claims Examiner I to join our team!

What you’ll be doing?

• Identify, research, process and resolve claims/system edit pending according to desk level procedures (DLP), business guidelines, and quality standards.
• Meet established productivity and timeliness standards to achieve individual and departmental performance goals as defined.
• Capable of investigative and analytical research, demonstrating critical thinking and deductive reasoning.
• Manage email proxy boxes and escalation emails as assigned.
• Consult and coordinate with various teams/departments to obtain information to ensure proper and timely resolution of claims/system edit pends.
• Demonstrate a high level of flexibility and adaptability; remain available to transition to different work groups based on business need.
• Employs strong organizational skills, makes good use of work time, and demonstrates an ability to effectively use all available resources to meet established claims processing goals.
• Demonstrate and maintain current working knowledge of the client’s systems, procedures, forms, and manuals as applicable.
• Experience with multi-tasking and prioritizing.
• Adhere to all corporate and client mandatory trainings, privacy and security protocols, time entry requirements, attendance and leave time policies and guidelines.
• Perform all other duties as assigned.
• Work from office is mandatory. The duties set forth above are essential job functions for the role. Reasonable accommodations may be made to enable individuals with disabilities to perform essential job functions. What we’re looking for? Required skills:
• Minimum: 15 years of continued education (bachelor’s degree or equivalent)
• Experience using current computer equipment and applications such as laptops and Microsoft Office Suite
• Proficiency with Ten Key and Typing skills.
• Ability to read and interpret Standard Operating Procedure documents and performance / production reporting.
• Basic level experience with MS Excel
• Ability to maintain confidentiality and privacy.