Claims Examiner

Job Summary

Detail-oriented and motivated, the remote Claims Examiner will accurately process medical claims, ensure compliance with plan documents and industry regulations, and manage 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 while maintaining production and accuracy standards

Required qualifications:

• At least 2+ years of experience in insurance claims processing
• 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