Claims Examiner

Job Summary

A company is looking for a Claims Examiner who will be responsible for verifying, adjudicating, and resolving insurance claims.

Key Responsibilities

• Reviews and validates claims for accuracy, completeness, and eligibility based on policy terms and guidelines
• Analyzes, adjudicates, and resolves claims by approving or denying documentation and calculating benefit amounts
• Ensures legal compliance with company policies and applicable state and federal regulations throughout the claims process

Required Qualifications

• High school diploma or equivalent required
• Intermediate computer skills, including email, database activity, word processing, and spreadsheets
• 1-3 years of healthcare reimbursement, claims processing, or customer service experience preferred
• Associate's degree or technical college coursework preferred
• Familiarity with Medicaid, Medicare, and commercial insurance claims preferred