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Nicklaus Children’s Health System
Miami, Florida
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Claims Examiner
JOB SUMMARY The Claims Examiner is accountable for claims processing, research and adjudication to correctly apply benefit determinations on routine medical claims (CMS 1500 and UB04) and Rx claims by claims processing guidelines. ESSENTIAL FUNCTIONS OF THE ROLE Processes and adjusts routine professional, facility and Rx claims according to claims processing guidelines. Pends claims as directed by departmental policies and procedures, follows up for resolution, and processes pended claims immediately following a benefit / payment determination. Maintains confidentiality rules in compliance with HIPPA guidelines.Works claims inventory from assigned queues to ensure all claims are processed within established turnarou
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