Claims Examiner

Job Summary

Working remotely, the full-time Associate Claims Examiner will adjudicate claims using PC/Microsoft Windows, ensuring accuracy in provider, member, and claim line information while meeting quality and management standards.

Key responsibilities

• Adjudicates claims using Facets and Macess Systems, ensuring accuracy of all claim-related information
• Investigates and resolves claim issues by coordinating with appropriate departments based on established criteria
• Maintains up-to-date knowledge of benefit changes and performs various responsibilities to enhance healthcare delivery

Required qualifications

• High School Diploma required; Associate degree in health, business, or related field preferred
• Previous related healthcare experience is required
• Knowledge of CPT, HCPCS, ICD-9-CM coding systems, and medical terminology preferred
• Strong PC skills required, with Microsoft Windows experience highly desired
• Availability to work full-time in a virtual setting from Schenectady or Rochester, NY