Claims Examiner

Job Summary

A company is looking for a Claims Examiner I.

Key Responsibilities

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

Required Qualifications

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