Claims Examiner II
Job Summary
Working remotely in a full-time capacity, the Claims Examiner II will analyze, investigate, and adjudicate medical claims, ensuring accurate processing and maintaining strong provider relationships.
Key responsibilities
- Process and adjudicate medical claims, including payments and denials, according to established coverage guidelines
- Maintain internal customer relations by collaborating with various departments and serving as a key contact for providers and members
- Research and update claims information, ensuring completeness and accuracy while contacting involved parties for additional details as needed
Required qualifications
- High School Diploma or Equivalent; some college education is a plus
- A minimum of 3 years of experience in medical claims adjudication
- Advanced knowledge of medical terminology, CPT-4, ICD-9-10 codes, HCPCS, ASA, and UB92 Codes
- Proficient understanding of claims processing policies and procedures
Complete Job Description
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