Claims Examiner

Job Summary

Detail-oriented and motivated, the remote Claims Examiner will accurately process medical claims, ensuring compliance with plan documents, policies, and industry regulations while managing individual inventory to meet production goals.

Key responsibilities:

• Adjudicate new claims and process adjustments, including denials upon receipt of additional information
• Review and resolve appeals and subrogation/third-party liability cases
• Respond to internal and external inquiries within established timeframes and follow up on missing or incomplete information

Required qualifications:

• At least 2+ years of experience in insurance claims processing required
• Experience with Third Party Administrator (TPA) or self-funded claims administration preferred
• Ability to interpret and apply plan documents for accurate claims adjudication
• Working knowledge of CPT and ICD-10 coding
• Associate Degree preferred