Health Claims Examiner

Job Summary

Working remotely, the full-time Health Claims Examiner will review, evaluate, and process health, drug, dental, and ancillary product claims to ensure accurate and timely insurance reimbursement in accordance with policy terms and regulations.

Key responsibilities

• Accurately review and verify healthcare claims submitted by policyholders or medical providers
• Ensure compliance with insurance guidelines, including eligibility, coverage, and applicable benefits
• Investigate and resolve complex claim issues, maintaining detailed records for audits and reviews

Required qualifications

• High school diploma or equivalent required
• Previous experience in healthcare claims processing, medical billing, or health insurance preferred
• Knowledge of medical terminology and coding standards (ICD, CPT)
• Strong organizational skills and attention to detail
• Ability to work efficiently under pressure and meet deadlines