Claims Examiner

Job Summary

Detail-oriented and experienced in claims processing, the temporary Claims Examiner will work remotely to process hospital and medical claims for self-funded and level-funded groups, determining payable amounts and ensuring accuracy for timely payments.

Key responsibilities:

• Process hospital and medical claims according to plan rules for self-funded and level-funded groups
• Determine payable amounts, deductibles, co-pays, and co-insurance limits based on fee schedules and insurance plans
• Identify billing discrepancies and coordinate necessary corrections with providers and internal teams

Required qualifications:

• Experience in claims processing for self-funded and level-funded groups
• Proficiency with CRM, Beacon Claims Administrative System, and Microsoft Office tools
• Ability to manage multiple priorities and adapt to new systems quickly
• Strong communication skills and sound judgment
• Attention to detail and efficiency in a fast-paced environment