Claims Examiner

Job Summary

Processing and adjudicating healthcare claims, the full-time Claims Examiner will manage claims for medical, dental, vision, and mental health services while conducting claims research and ensuring compliance with policy guidelines, all in a remote work environment.

Key responsibilities

• Handle day-to-day processing and adjudication of healthcare claims, ensuring accuracy and compliance with policy guidelines
• Facilitate claims investigations, negotiate settlements, and manage overpayment reviews and recovery
• Resolve claims appeals and verify benefits while maintaining effective communication with healthcare providers and clients

Required qualifications

• 2+ years of related work experience in claims examination or adjudication within the healthcare industry
• High school diploma or GED
• Knowledge of CPT and ICD-10 coding, as well as COBRA, HIPAA, and coordination of benefits
• Proficiency in Microsoft Windows, Word, and Excel, along with experience using computerized claims payment systems
• Strong judgment and decision-making skills, with the ability to analyze complex information effectively