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Claims Examiner

Miami, FL 33186

Posted: 04/20/2023 Employment Type: Temp-Hire Category: Healthcare Job Number: 259761 Pay Rate: 20.00

Job Description

About The Client

One of Fortune's 2019 Best Places to Work. It's the state's only healthcare provider to make the list for the 19th time. This recognition is based on employee ratings of their workplace culture, including trust in leaders, job pride, and co-worker camaraderie. Patients rate us highly. Our medical expertise brings international patients and their families to Miami.

Our success derives from a company-wide culture of excellence and dedication. Our quality comes from their kindness, compassion, and dedication to clinical and service excellence.

Position will be fully remote with the need to be flexible if on-site team building were to be scheduled.
This position will be doing physician payments, reconciliation of provider payments, physician inquires, and running reports.

Job Responsibilities:

• Responsible for system-wide Claims Management and Third Party Administrative (TPA) tasks.
• Accurate audits, claim analysis, payer collections, and medical claim adjudication are key duties.
• Establish and manage the PNS Contract Management Process.
• Team Lead(s) support Para-Claim Parathion solution management by assessing claim data for anomalies, trends, and inconsistencies.
• Responsible for all line-of-business physician claims appeal and reimbursement reconsideration.
• Helps Team Lead(s) and leadership enhance departmental processes.
• Helps department leaders and Team Lead with payment and reconciliation.

Job Qualifications:

• Requires an associate degree with a minimum of 6 months experience or High School Diploma with a minimum of 1-year experience.
• Minimum of 6 months’ experience required; 5 years preferred.
• Must understand revenue cycle and UB forms.
• Accounts payable/Accounts Receivable/Accounting experience.
• Must be highly detail oriented with skilled data entry.
• Preferred experience in the following areas - Power BI or Smart sheets experience, Certified Coder/Biller, Healthcare Background, Claims Experience

Meet Your Recruiter

Melissa Matos




Hello – I am Melissa Matos and I love what I do – recruiting in the Healthcare space and putting people to work! I was born in Puerto Rico and raised in New York, then I moved to sunny South Florida 20+ years ago where I’ve been with Lloyd since 2002. I work closely with clients and candidates to understand the talent and career needs of both groups. My bilingual fluency is an asset to positions where a second language is critical to the regional culture and busines demands. Healthcare is one of the fastest growing industries in the U.S.; my searches and placement successes are nationwide.  I head up an outstanding group of recruiters focused on the healthcare community. We know we have made an impact on our client’s workforces and are proud of the contributions our healthcare talent has made, particularly during the pandemic. We look forward to a world of wellness! #LIVINGLLOYD

Song I can listen to over & over:  Anything by Marc Anthony (Salsa music!)


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