Medical Claims Examiner

Job Summary

A company is looking for a Medical Claims Examiner - Remote U.S.

Key Responsibilities

• Process professional and hospital claim forms submitted by providers
• Review policies and benefits while ensuring compliance with HIPAA and confidentiality regulations
• Adjudicate claims according to defined workflows and maintain quality scores above established targets

Required Qualifications

• 2 years of healthcare claims processing experience (full cycle: Pay, Pend, Deny)
• 2 years of experience using Windows applications and navigating multiple computer systems
• High school diploma or GED
• Experience with Amisys or Xcelys is a plus
• Ability to effectively communicate in a professional office setting