Do you want to make a difference in the healthcare industry? Western Growers Assurance Trust (WGAT) is looking to expand its team with a claims examiner who will be responsible for reviewing, analyzing, and processing healthcare claims.
WGAT is the largest provider of health benefits for the agricultural industry. Its mission is to offer quality health plans to all its members and participants.
The non-profit organization saw the need for employer-sponsored health benefit plans back in 1957 and has been working hard to serve employers and employees ever since.
Working as a claims examiner may not be the most exciting job in the world, but it is remote and pays well. Expect to receive anywhere from $2,630 to $3,836 per month, plus a rich benefits package that includes profit-sharing.
What does the job entail?
The role of a claims examiner involves a variety of duties, among them:
- Inspecting claim files for eligibility or authorization
- Working closely with healthcare providers to obtain claims documentation
- Analyzing patient and medical information to determine claim benefits or coordination benefits
- Processing low-level claims
- Researching, completing, and processing paper or electronic claims
- Resolving eligibility issues
- Ensuring legal compliance with the Health Insurance Portability and Accountability Act (HIPAA), company policy, and guidelines
- Ensuring patient data protection by implementing necessary security techniques
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These duties and responsibilities pertain to claims processing and quality assurance. When it comes to problem-solving, judgment, and compliance, the job requires you to do the following:
- Examine a problem thoroughly before making a decision.
- Work closely with the team to find alternatives to resolve problems within a realistic timeline.
- Notify higher management when you identify potential high-risk compliance issues.
- Ensure compliance at all times.
- Make rational decisions in a comprehensive way based on available information.
What do you need to qualify?
The successful candidate has a high school diploma or equivalent and at least one year of experience as a health claims examiner or previous experience in a similar industry.
In addition to that, you need to meet the following criteria:
- Excellent written and verbal communication skills
- Ability to make timely and effective decisions
- Ability to work under pressure
- Ability to interpret plan documents or summary plan descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination
- Knowledge of basic medical terminology
- Proficiency in Microsoft Office
- Fast typing speed (at least 40 words per minute)
- Familiarity with UB-04 and HCFA 1500 forms (837/5010 format), ICD10, CPT, and HCPCS codes
- Familiarity with guidelines regarding the Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines
Do you think you have what it takes to become the new claims examiner for WGAT? Then go ahead and fill out the application form here. Once you’ve submitted it, you will receive an email with instructions to check the application status. Good luck!