Insurance Claims Examiner IIHere's what you'll be doing:Level IIAnalyzes and processes minimum of 200 claims daily to determine plan liability; reviews payment Purchased Referred Care, medical, dental and vision claimsCompiles, submits documents, and tracks claims for CHEF, (Catastrophic Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases, following current IHS guidelines and regulationsCollaborates with the Eligibility team to ensure payer of last resort stance is utilized when handling Purchased Referred Care claims and paymentsAssists with other research and development projects as directed by Management; obtains and maintains necessary certification for Health Insurance Marketplace CACReviews, resolves and/or escalates Level 2 claims appeals; releases claims up to the designated draft authority for Level 2 Claims ExaminerEnsures that claims adjudication complies with all FCPID standards and protocols; reviews claims for possible abuses and/or fraud and bring to the attention of managementWhat you'll need to be successful:Level IIHigh School Diploma or GEDFive (5) years of experience in medical claims processingThree (3) years in customer serviceKnowledge of Indian Health Service guidelines as it pertains to payment of medical providers and health benefits claims processing standardsKnowledge of NCCI and CMS coding/billing standards, CPT-4, ICD-9, ICD-10, DRG and HCPS and medical terminologyKnowledge of insurance principles and/or proceduresSkill in operating various word-processing, spreadsheets, and database software programs in a Windows environmentMust successfully pass all applicable background checks and drug screensBenefits you'll love:Approximately 5 weeks of paid time off annually3 weeks of paid holidaysPremium free health insuranceFlexible spending accountsShort term disabilityLife insurance401k with matchEqual Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.