Claims Examiner

Job Summary

A company is looking for a Claims Examiner.

Key Responsibilities

• Examine, review, and process claims according to contractual obligations and regulations
• Assess appropriateness of claims and ensure timely processing standards are met
• Assist partners with inquiries related to claims decisions or statuses

Required Qualifications

• High School Diploma or Equivalency; professional experience may substitute
• Minimum of three years of experience in claims processing within a managed care environment
• Working knowledge of health plan insurance industry and relevant regulations
• In-depth experience with Medicare and Medicaid claims processing
• Demonstrated skills in Microsoft Office Applications and electronic claims processing systems