Claims Examiner

Job Summary

A company is looking for a Claims Examiner I.

Key Responsibilities

• Process and adjudicate healthcare claims, including claims research and verification of medical necessities
• Facilitate claims investigation, negotiate settlements, and manage overpayment reviews
• Resolve claims appeals and verify correct plan loading

Required Qualifications

• 2+ years of related work experience in claims examination/adjudication
• High school diploma or GED
• Knowledge of CPT and ICD-10 coding
• Understanding of COBRA, HIPAA, and coordination of benefits
• Proficiency in Microsoft Windows and Word, Excel, and medical CPT coding programs