Claims Examiner

Job Summary

Processing and adjudicating healthcare claims, the full-time Claims Examiner will conduct claims research, verify medical necessities, and manage overpayment investigations while working remotely.

Key responsibilities

• Handle day-to-day processing and adjudication of medical, dental, vision, and mental health claims
• Facilitate claims investigations, negotiate settlements, and manage overpayment reviews and recoveries
• Resolve claims appeals and verify correct plan loading and benefits

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-9 coding
• Familiarity with COBRA, HIPAA, and coordination of benefits
• Proficiency in Microsoft Windows, Word, Excel, and customized medical coding programs