QUALIFICATIONS: REQUIRED TESTING: Alpha-Numeric Data Entry test (4000 keystrokes per hour) JEPS Math Ten Key Data Entry test (6000) Minimum REQUIRED: High School diploma or GED 1-year successful senior claims examiner PHYSICAL REQUIREMENTS: This position requires a high degree of close visual perception, and normal manual dexterity. Incumbent must be able to sit for prolonged periods of time. Must be able to speak, read and write English fluently. POSITION PURPOSE: Service excellence is to be centered on patient care and patient relationships and is the responsibility of all employees. Teamwork is the norm and all employees will be held accountable to work as effective team members. Primarily responsible for the timely and accurate processing of adjustment claims for HealthPartners products. ACCOUNTABILITIES: Review adjustment from all areas within HealthPartners and interpret instructions. Determine errors of previous claims processed. Adjustment of all claims involving overpayments, underpayments and other irregularities. Determination of refund process vs. void and replace process to avoid any credits being created on the DEC system. Assign appropriate procedure, service components and diagnosis codes as necessary to determine correct benefits. Correspond with members, Customer Service Unit, Member Services, Network Management, Membership Accounting, clinics, Patient Accounting, other insurance carriers and other departments regarding adjustment processes. Determine benefit coverage through interpretation of various member contracts provisions and state of federal law and HP policies and procedures. Approve claims for payment/rejection in accordance with specific contacts and company policies. Respond to phone inquiries and member correspondence inquiries regarding claims adjustments. Compile statistical information regarding reviewed claims and report results to appropriate Supervisor. Meet established production and quality standards. Work in a team setting with CCSEs and Member Services to ensure the adjustment accuracy. Keep abreast of current information and changes impacting claims processing. Organize relevant information for daily reference. Back up to the Customer Service area when phone coverage is needed. Perform other duties as assigned by HP management. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.