Claims Examiner I (Remote within Wisconsin)

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world!

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*Current Wisconsin Residents Only Eligible to Apply*

JOB SUMMARY

The SHP Claims Examiner I is responsible for examining claims for accurate processing and providing high quality customer service to providers working with Security Health Plan (SHP) or Security Administrative Services (SAS).  The individual applies appropriate processing guidelines to the benefit plans and follows established departmental, organizational and external policies and procedures to process claims and resolve claim issues, escalating the claim when applicable.

JOB QUALIFICATIONS

EDUCATION

For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation.

Minimum Required: High school diploma or equivalent. Successful completion of the following courses per departmental procedures, within one year of hire:  current procedural terminology (CPT), current international classification of diseases (ICD) health care procedure coding system (HCPCS), and medical terminology.

Preferred/Optional: Successful completion of the following post-secondary courses at time of hire:  current procedural terminology (CPT), current international classification of diseases (ICD) health care procedure coding system (HCPCS), and medical terminology.

EXPERIENCE 

Minimum Required: One year experience in the medical or insurance industry. In lieu of one year experience in the medical industry will accept two years’ of Customer Service experience to qualify.

Preferred/Optional: None

CERTIFICATIONS/LICENSES 

The following licensure(s), certification(s), registration(s), etc., are required for this position.  Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position.

Minimum Required: None

Preferred/Optional: None

Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare.  Successful applicants will listen, serve and put the needs of patients and customers first.

At Marshfield Clinic Health System, we are fully committed to addressing health equity, diversity and inclusion for our employees and providers, our patients, and the communities we serve. We believe that every individual should have the opportunity to attain their highest level of health. We embrace diversity and welcome differences in who we are and how we think. We believe that any individual or group should feel welcomed, respected and valued. View our Equity and Inclusion Statement here.

Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid.  This is a condition of employment.  Employee must immediately notify his/her manager or the Health System’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.