Claims Examiner
Job Summary
Reviewing written dispute requests from providers regarding denied or incorrect payments, the temporary remote Claims Examiner will interpret contracts, adjust claims, and communicate resolutions while ensuring compliance with established guidelines.
Key responsibilities
- Review and interpret provider and health plan contracts to ensure accurate claims processing
- Adjust claims as necessary, including calculating interest and penalties, and document disputes accurately
- Monitor warning reports and communicate with providers regarding disputes in a clear and concise manner
Required qualifications
- Experience in claims examination or a related field
- Knowledge of RBRVS and Medicare guidelines
- Ability to interpret contractual agreements effectively
- Familiarity with claims processing systems and compliance requirements
- Proficiency in documenting and reporting on claims disputes
Complete Job Description
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