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Claims Examiner
Purpose Statement / Position SummaryThe Claims Examiner I accurately review, researches and analyzes professional claims.  Makes benefit determinations and calculations of type and level of benefit based on established criteria and provider contracts.Essential Functions and Responsibilities of the Job Knowledge of CPT/HCPC and ICD-9/ICD-10 codes and guidelines.Comprehensive knowledge of DMHC and CMS guidelines to accurately adjudicate Commercial and Medicare Advantage claims.Process HCFA 1500s and COB claims.Reviews, processes and adjudicate claims for payment accuracy or denial of payment according to Department’s polic


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