Claims Examiner - (Billings, MT)

Job Summary: This position properly applies plan provisions on self-funded groups. This position is responsible for claims processing of medical, dental and vision claims, and answers questions in accordance with relevant terms and established procedure. This individual works closely with other departments to proactively research concerns and resolve to the satisfaction of the client. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility. Essential Duties and Responsibilities: 1. Claims Processing 1.1. Interprets plan documents. 1.2. Reviews, researches, and analyzes info to determine eligibility. 1.3. Processes, denies, pends, or allows claims. 1.4. Uses thought and reasoning to manage workload that carries an average level of financial risk. 2. Correspondence 2.1. Accurately notes the system of all details received. 2.2. Forwards all records. 3. Group Contacts 3.1. Tracks and returns calls and e-mails. 3.2.