Claims Examiner

Job Summary

A company is looking for a Claims Examiner to accurately process medical claims while ensuring compliance with relevant regulations.

Key Responsibilities

• Adjudicate new claims and process adjustments, including denials
• Review and resolve appeals and subrogation/third-party liability cases
• Manage individual inventory to meet timely turnaround and production goals

Minimum Qualifications

• Associate's degree preferred
• Experience with Third Party Administrator (TPA) or self-funded claims administration preferred
• At least 1+ year of experience in insurance claims processing
• Working knowledge of CPT and ICD-10 coding
• Basic understanding of medical terminology