Claims Examiner

Job Summary

A company is looking for a Claims Examiner to manage non-auto adjudicated claims and ensure compliance with relevant regulations.

Key Responsibilities

• Accurately adjudicate claims and resolve discrepancies to contribute to overall Claims Production productivity
• Maintain adherence to internal controls and compliance with applicable laws and regulations
• Identify and report any unethical or fraudulent activity related to business operations

Required Qualifications, Training, and Education

• High School diploma with a minimum of 3 years of relevant healthcare claims insurance administration experience
• Knowledge of healthcare payer industry standards and regulations (e.g., HIPAA, ACA, CMS)
• Familiarity with industry coding standards/forms (e.g., CPT4, ICD10, UB04, HCF1500)
• Experience with health claims processing systems and handling confidential information
• Proficiency in Microsoft Office products