Bilingual Claims Examiner

Job Description:

Are you an experienced Claims Representative looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities:  

• Resolves Provider Reconsideration Requests (PRR) from providers relating to claims payment and requests for claim adjustments

• Researches claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error

• Identifies potential Provider problems through a proactive approach in which data is mined and trended to identify and prevent provider problem areas