Claims Examiner

Job Summary

Processing and adjudicating healthcare claims, the full-time Claims Examiner will handle claims research, verify medical necessities, and facilitate overpayment administration while working remotely.

Key responsibilities

• Process and adjudicate medical, dental, vision, and mental health claims, ensuring compliance with policy guidelines
• Investigate claims, negotiate settlements, and manage overpayment reviews and recovery
• Resolve claims appeals and research 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 and HIPAA regulations
• Proficiency in Microsoft Windows, Word, and Excel, along with customized medical coding programs
• Strong judgment and decision-making skills with the ability to analyze complex information