Claims Examiner

Job Summary

A company is looking for a Claims Examiner.

Key Responsibilities:

• Adjudicate healthcare claims based on specific policies and procedures
• Review claims processing system data and compare it with corresponding UB04 or CMS1500
• Review adjudication software system's claim and line item edits to determine payment

Required Qualifications:

• High School degree with one year of relevant professional experience in Healthcare claims operations
• Proficiency in MS Office applications, especially Word and Excel
• Knowledge of physician billing practices and hospital coding, billing, and medical terminology
• Ability to analyze claims data and present findings in a structured way
• One year of claims or billing operations experience in a healthcare setting