Claims Examiner

Job Summary

Processing medical claims and handling customer service inquiries, the full-time Claims Examiner will work remotely to ensure timely and accurate claims processing while serving as a point of contact for members and providers.

Key responsibilities

• Process medical claims and correspondence with acceptable accuracy and timeliness
• Answer inbound calls and handle inquiries from members and providers
• Analyze self-funded health plans and interpret plan design to address claim edits and inquiries

Required qualifications

• Familiarity with ICD-10 and CPT coding
• Understanding of medical claims processing guidelines
• Proficient PC skills, including email, record keeping, and spreadsheet management
• Experience with QicLink
• High school diploma with 1-2 years of related experience or equivalent combination of education and experience