Healthcare Claims Examiner

Job Summary

A company is looking for a Healthcare Claims Examiner.

Key Responsibilities

• Review and process claim submissions for compliance with coverage guidelines and regulations
• Approve, pending, or deny claims based on coverage guidelines and system data
• Maintain effective internal customer service by researching claim issues and updating claim files

Required Qualifications

• 1+ years of Medicaid and commercial claims payer processing experience
• High school diploma or equivalent
• Knowledge of medical terminology and billing codes (CPT-4, ICD-9, ICD-10, HCPCS, ASA, UB92)
• Strong Medicaid knowledge
• Proficient in Microsoft Office and ability to navigate multiple systems