Claims Examiner

Job Summary

Reviewing written dispute requests from providers, the temporary remote Claims Examiner will interpret contracts, adjust claims, and communicate resolutions while ensuring compliance with guidelines.

Key responsibilities

• Review and interpret provider and health plan contracts for accurate claims processing
• Adjust claims and calculate interest and penalties as necessary
• Document disputes in the Provider Dispute Database and communicate outcomes to providers

Required qualifications

• Experience in claims processing and dispute resolution
• Knowledge of RBRVS and Medicare guidelines
• Familiarity with provider and health plan contracts
• Ability to organize and manage workload efficiently
• Proficiency in using database systems for documentation and reporting