Claims Examiner I

Job Summary

Processing healthcare claims in a full-time capacity, the Claims Examiner I will manage adjudication, claims research, and overpayment administration while working remotely.

Key responsibilities

• Process and adjudicate medical, dental, vision, and mental health claims while ensuring compliance with policy guidelines
• Facilitate claims investigations, negotiate settlements, and manage overpayment reviews and recovery
• Resolve claims appeals and verify correct plan loading and benefits

Required qualifications

• 2+ years of related work experience in claims examination or adjudication within the healthcare industry
• High school diploma or GED
• Knowledge of CPT and ICD-9 coding
• Familiarity with COBRA, HIPAA, and coordination of benefits
• Proficiency in Microsoft Windows, Word, and Excel