Claims Examiner

Job Summary

Claims Examiner, a full-time position responsible for processing and adjudicating healthcare claims, conducting claims research, and ensuring compliance with policy guidelines.

Key Responsibilities

• Process and adjudicate medical, dental, vision, and mental health claims
• Conduct claims investigations, negotiate settlements, and manage overpayment reviews
• Resolve claims appeals and verify correct plan loading and benefits

Required Qualifications

• 2+ years of related work experience in claims examination or adjudication
• High school diploma or GED
• Knowledge of CPT and ICD-9 coding
• Familiarity with COBRA, HIPAA, and coordination of benefits
• Experience with computerized claims payment systems in the healthcare industry