Health Partners Plans


Job Information

Why Choose Health Partners Plans?

Health Partners Plans is an award-winning, not-for-profit health maintenance organization serving more than 280,000 members for more than 30 years. Health Partners Plans has been doing it right and improving health and wellness in communities throughout the Greater Southeastern Pennsylvania region.

Perks of HPP and why you will love it here:

  • Competitive Compensation Packages including 401(k) Savings Plan with Company Match and Profit Sharing
  • Flextime and Work-at-Home Options
  • Benefits & Wellness Program including generous Time Off
  • Diversity & Inclusion commitment
  • Impact on the communities we service
We are hiring a Claims Examiner to join our team remotely!

Working under general supervision, the Claim Examiner adjudicates medical claims, in accordance with Health Partners' policies and procedures.

As the Claims Examiner, your daily duties may include…
  • Accurately adjudicates claims in compliance with data entry rules, On Line Processing Rules and contractual agreements.
  • Reviews pended claims on a daily basis, assuring that all appropriate documentation is completed before adjudication.
  • Accurately completes service forms for pended claims and routes to designated areas for resolution.
  • Reviews audit results on a weekly basis, correcting errors in the claims processing system within designated timeframes.
  • Follow established procedures and guidelines for claims processing and high dollar claim review.
  • Maintains minimum performance standards as specified by departmental policies, such as claim production and accuracy.
  • Keeps current with Claims Department policies and procedures.
  • Assist the unit in meeting and maintain performance standards.
Qualifications and Skills:
  • High school diploma or equivalent
  • Two or three years of claims processing experience or provider billing experience
  • Excellent communication skills required-both oral and written
  • Ability to maintain strict confidentiality of patient information obtained in the performance of job function
  • Basic understanding of computer applications
  • General understanding of the principles of Managed Care
HPP is a nationally recognized company for their innovations in care, Health Partners Plans is more than your average health care company and can help you achieve your career goals!

Other details
  • Pay Type Hourly
  • Philadelphia, PA, USA

Health Partners Plans

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