Facets Claims Examiner
Job Summary
Seeking experienced professionals, the full-time Facets Claims Examiner will remotely manage the manual review and processing of complex healthcare claims within the Facets platform, focusing on Coordination of Benefits (COB) and ITS Home/Host claims.
Key Responsibilities
- Manually review, evaluate, and process healthcare claims within the Facets platform
- Research and resolve complex claim scenarios requiring interpretation of benefits, plan provisions, and payment rules
- Identify claim discrepancies, determine appropriate resolutions, and document claim-processing decisions accurately
Required Qualifications
- Current and hands-on experience as a Facets Claims Examiner with advanced knowledge of Facets claims processing
- Demonstrated experience manually processing healthcare claims, including complex and exception-based scenarios
- Current experience with Coordination of Benefits (COB) or ITS Home/Host claims
- Ability to analyze claim details and supporting documentation for accurate processing decisions
- Strong attention to detail and commitment to quality in a production-oriented environment
Complete Job Description
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