Collaborating with a team of dedicated, reliable, and skilled professionals is essential to ensuring each client reaches their goals and achieves extraordinary results.
We are always looking for qualified, motivated candidates to join our team and build with passion. People with similar values, dedication and standards of excellence.
Our hiring process examines the values and integrity of each candidate as much as his or her technical skillset. We seek candidates who will make individual contributions to projects, but who will also look for ways to contribute to our shared objectives.
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Senior Claims Examiner
Danvers, MA 01923
The Claims Examiner is responsible for the following, within a dedicated unit serving the HMO/Provider Excess, Stop Loss and Reinsurance Claims needs of our clients.
Knowledge and experience adjudicating accident and health medical claims and/or pharmacy benefits for traditional medical, employer stop loss specific and aggregate excess, HMO Re or provider excess claims.
- Audit and review of managed care and provider excess provider agreements and healthplan/TPA contracts and adjudicating claims accordingly.
- Audit and review of employer stop loss specific and aggregate excess claims.
- Consulting with clients, intermediaries and peer reviewing the work of others.
- Occasional travel is possible.
- A minimum of 2+ years medical claims experience
- Ability to work independently and collaborate on assignments in a fast-paced environment.
- Knowledge of first dollar medical claims, claim processing platforms, and medical terminology is required.
- Experience in self-insured plans and/or managed care plans is preferred.
- Excellent written, verbal, and analytical skills and attention to detail is required.
- Strong Word, Excel, Access skills.
Full benefits package offered. Salary is commensurate with experience.
Northshore is a consulting and insurance services organization that specializes in audit, claims management and subrogation services. Our clients include organizations in the accident and health, property and casualty insurance industries, employers, governmental entities, and other risk assumption vehicles.
Northshore provides services worldwide and is headquartered in Danvers, Massachusetts with offices throughout the United States.