What are the responsibilities and job description for the Medical Claims Examiner position at Preferred Health Plan?
Company Description
Preferred Health Plan (PHP) is a health care administrator committed to providing effective, self-funded health plans that are tailored to the unique needs of employers. With a foundation built on experience, technological expertise, and exceptional service, PHP prides itself on creating and implementing innovative health care solutions. Based in the Carolinas, PHP is dedicated to helping employers manage health care with ease and efficiency.
Role Description
This is a full-time, on-site role located in Matthews, NC, for a Medical Claims Examiner with a customer service focus. The role is responsible for reviewing and processing medical claims while delivering high-quality service to members, providers, and internal stakeholders.
Primary responsibilities include examining medical claims for accuracy and compliance with plan policies and procedures, verifying appropriate coding, coordinating benefits, and identifying and resolving discrepancies. In addition, this role involves responding to claim-related inquiries via phone, email, or written correspondence; explaining claim determinations clearly and professionally; and ensuring concerns are addressed in a timely, courteous, and solution-oriented manner. The Medical Claims Examiner works collaboratively with internal teams to support efficient claims resolution and a positive customer experience.
Qualifications
- Experience and proficiency in medical claims processing and insurance claims handling
- Strong understanding of medical terminology and healthcare billing/coding concepts
- Knowledge of self funded insurance policies, procedures, and benefits coordination
- Customer service experience, preferably in a healthcare or insurance setting
- Ability to communicate claim information clearly and professionally to members and providers
- Strong attention to detail and accuracy in reviewing claim documentation
- Effective organizational, problem-solving, and time-management skills
- Ability to work collaboratively in an on-site and virtual team environment
- Relevant experience in the healthcare or insurance industry is preferred
- High school diploma or equivalent required; advanced education or certifications in healthcare or insurance-related fields are a plus