Claims Examiner II

Corizon Health is the pioneer and foremost provider of correctional healthcare in the United States. We are a company built on more than 35 years of innovation and expertise in the industry to become the biggest and the best.

The Claims Examiner II will process medical and dental coordination of benefits claims in a correctional environment. You must maintain knowledge of provider and client contracts applying any contractual agreements that affect payment reimbursement.

• Process hospital, physician, dental and ancillary provider claims accurately based on medical authorization and apply all applicable coding edits and contractual agreements.
• Utilize tools such as Microdyn, Claim Check and Virtual Examiner
• Review claims for potential fraud, waste and abuse; hospital acquired conditions and never events.
• Maintain production and accuracy requirements as set forth by Claims Policy and Procedures.

• High school graduate; college preferred.
• Experience using Excel, Word and Outlook; QNXT claim system experience preferred.
• Three (3) years experience claim processing in a managed care environment.
• HIAA, coding or other industry related courses.