Claims Examiner

Job Summary

A company is looking for a Claims Examiner.

Key Responsibilities

• Assess appropriateness of returned, denied, or paid claims by reviewing contractual obligations and regulations
• Work with management to establish and maintain claims processing rules that meet regulatory and business requirements
• Assist internal and external partners with inquiries related to claims decisions or statuses

Required Qualifications

• Minimum of three (3) years of experience in processing, researching, and adjudicating claims in a managed care environment
• In-depth experience with Medicare and Medicaid claims processing
• Demonstrated experience with Microsoft Office Applications and electronic claims processing systems