Customer Service rep/ Claims Examiner

Job Description

Do you enjoy providing great customer service? Do you have experience with medical billing or claims? If you answered yes to these questions the Office of Medicaid Operations with the Utah Department of Health and Human Services invites you to appy as a Medicaid Claims Examiner II.

The Medicaid Claims Examiner II position has two primary functions, to answer incoming customer service calls and to process all types of medical claims based on Medicaid guidelines.

You will be required to be logged into the phone system for up to 7 hours / day and take between 70 to 100 calls a day. After training, this position may be eligible to telework from home for up to 3 days per week, with 2 in-office days.

Principal Duties

As a Medicaid Claims Examiner II you will :

• Answer calls about Medicaid benefits, claims, billing practices, and other related information from the medical community and public.
• Adjudicate claims.
• 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.

This job may be filled at either of the levels listed below. (Rates as listed or in accordance with DHRM Rule for current state employee.)

• Claims Examiner II, $20.49 - $35.38 per hour.
• Claims Examiner I, $18.95 - $31.61 per hour. (As a Claims Examiner I, you will receive on the job training and perform the duties described above under close supervision.)

The Ideal Candidate has

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

Why You Should Join Our Team

Note : as of April 8, 2024, DHHS employees will be working a hybrid schedule, which includes 2 office days per week and 3 telework days.

Why work for the Utah Department of Health and Human Services? In addition to the rich benefits the State of Utah offers, the department offers :

• On-site fitness center, for a minimal membership fee
• UTA Eco Pass, at a discounted monthly rate
• Teleworking opportunities with a minimum 2 office days per week beginning 04 / 2024.
• On-site day care center at the Cannon Health Building with First Steps Day Care - contact for rates and availability, 801-538-6996

If offered this position, your employment will be contingent upon passing a background check and review. There will be no cost to you for this check.

This check will include fingerprinting, which will be available at various DHHS locations for your convenience. Fingerprinting will be completed prior to your first day of employment.

You may review the policy by clicking here.

The Agency

For more information on the Utah Department of Health and Human Services, please click here .

Supplemental Information

• Effective July 1, 2021, State of Utah Employees must either reside in Utah or be in the process of relocating to within 30 days of their start date.
• This position may currently be a hybrid of both in-office and remote work days. Please note, a position's eligibility for remote work is established by agency management and is subject to change at their discretion, at any time and for any reason.
• The typical office setting for this job is adequately lighted, heated and ventilated. However, you may encounter some risks that are associated with any office setting, for example, the safe use of office equipment, avoiding trips and falls, observing fire regulations, etc.
• Typically, the employee may sit comfortably to perform the work; however, there may be some walking; standing; bending;

carrying light items; driving an automobile, etc. Special physical demands are not required to perform the work.

• Standard Schedule : Monday - Friday, 8 : 00 am to 5 : 00 pm
5 days ago