Claims Examiner

Job Summary

Detail-oriented and experienced, the Claims Examiner will process hospital and medical claims for self-funded and level-funded groups remotely, ensuring accuracy and adherence to policy rules in a temp-to-hire position.

Key responsibilities:

• Process hospital and medical claims, determining payable amounts, deductibles, co-pays, and co-insurance limits
• Review, adjust, and process claims to ensure accuracy and compliance with policy
• Collaborate with internal teams to resolve complex claims issues and address billing discrepancies

Required qualifications:

• Experience in claims processing for self-funded and level-funded groups
• Ability to manage multiple priorities and thrive in a fast-paced environment
• Familiarity with CRM, Beacon Claims Administrative System, and Microsoft Office tools
• Strong communication skills and sound judgment
• Detail-oriented with the ability to identify trends and opportunities for improvement