Medical Claims Examiner

Job Summary

Working remotely, the Medical Claims Examiner will process professional claim forms, review policies and benefits, and ensure compliance with HIPAA regulations while maintaining high-quality scores and meeting client productivity targets.

Key responsibilities

• Process and adjudicate claims according to defined workflows and guidelines
• Research, review, and act on claims while ensuring timely responses and resolutions
• Maintain quality scores above 98.5% for PA and 99.75% for FA, adhering to productivity targets

Required qualifications

• 1-3 years of hands-on experience in healthcare claims processing and claims adjustments
• High school diploma or GED
• 2+ years of experience using Windows applications and navigating multiple computer systems
• Familiarity with MS Office products, including Outlook, Word, and Excel
• Ability to work 8 am - 4:30 pm EST online/remote, with required on-camera training