Claims Examiner

Job Summary

A company is looking for a Claims Examiner I who will handle processing and adjudication for healthcare claims.

Key Responsibilities

• Process and adjudicate medical, dental, vision, and mental health claims
• Conduct claims research and verify medical necessities and coverage under policy guidelines
• Facilitate claims investigations, negotiate settlements, and manage overpayment reviews

Required Qualifications

• 2+ years of related work experience in claims examination/adjudication
• High school diploma or GED
• Knowledge of CPT and ICD-9 coding
• Familiarity with COBRA, HIPAA, and coordination of benefits
• Proficiency in using Microsoft Windows, Word, Excel, and medical CPT coding programs