Customer Service Rep Claims Examiner

Process Medical & Dental claims for our Group Clients. Determine if claims can be paid, rejected; pend or refer claims. Answer customer service calls and provides first call resolution and support to members, clients and providers. This is a full-time, hourly position on the UCHealth Plan Administrator team based in Lone Tree, CO.

Job Duties

• Creates reports on credentialing productivity, appeals and provider performance. Responds to claims appeals. Analyzes and pays, denies or requests additional information on claims based on eligibility, coordination of benefits and plan specifications.
• Maintains files on pended claims. Investigates COB information and coordinates calculation of benefits. Investigates claims for subrogation with third party liability.
• Answers incoming calls and resolves issues. Processes flex claims according to federal reimbursement guidelines, publication 502.
• Verifies eligibility and benefit questions.

Requirements

• High School Diploma or GED
• 5 years of experience in a health care setting in more than one of the following areas: provider relations, credentialing, claims, customer service.

Preferred

• 5 years of experience in health insurance

• 5 years of customer service experience

• Experience working in a TPA environment

• Medical coding knowledge

At UCHealth, we do things differently

We believe in something different: a focus on the individuality of every person. In big ways and small, we exist to improve the extraordinary lives of all those we serve. As Colorado's largest and most innovative health care system, we as a team deliver on the commitment to provide the best possible experience for our patients and their families. We foster a true human connection and give people the freedom to live extraordinary lives. A career at UCHealth is more than a job, it's a passion.

Going beyond quality requires the perfect balance of talent, integrity, drive and intellectual curiosity. We are looking for individuals who recognize, like us, that the world of medicine is ever-changing and are motivated to do what is right, not what is easy. We support creativity and curiosity so that each of us can find the extraordinary qualities within ourselves. At UCHealth, we'll do everything in our power to make sure you grow and have a meaningful career. There's no limits to your potential here.

Be Extraordinary. Join Us Today!

The University of Colorado Health (UCHealth) system recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an affirmative action/equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, creed, color, religion, gender, national origin or ancestry, age, mental or physical disability, sexual orientation, gender identity, transgender status, genetic information or veteran status. UCHealth does not discriminate against any "qualified applicant with a disability" as defined under the Americans with Disabilities Act and will make reasonable accommodations, when they do not impose an undue hardship on the organization.