Customer Service Representative/Claims Examiner

About the position

The Medicaid Claims Examiner II position at the Utah Department of Health and Human Services focuses on providing excellent customer service and processing medical claims according to Medicaid guidelines. The role involves answering customer inquiries, adjudicating claims, and explaining Medicaid billing policies. This position may allow for hybrid work, with a combination of in-office and telework days after training.

Responsibilities

• Answer calls about Medicaid benefits, claims, billing practices, and related information from the medical community and public.
• Adjudicate claims based on Medicaid guidelines.
• Respond to phone, electronic, fax, and mail inquiries regarding the status and correction of claims.
• Explain and interpret Medicaid billing policies, guidelines, benefits, and procedures.
• May spend time in the document control area.

Requirements

• Experience processing and adjusting electronic and paper claims.
• Experience with medical billing or collections.
• Excellent customer service skills.

Nice-to-haves

• Supervising experience.

Benefits

• Disability insurance
• Health insurance
• On-site gym
• Dental insurance
• Life insurance
• On-the-job training