Medical Claims Examiner

Job Summary

A company is looking for a Claims Examiner to ensure the financial integrity and efficiency of their healthcare organization.

Key Responsibilities

• Adjudicate a variety of claims, resolving system edits and audits for submissions
• Communicate with providers and members to address claims-related issues
• Process third-party liability claims and assist in the review of stop loss reports

Required Qualifications

• High school diploma or equivalent
• 1-3 years of medical claims processing experience
• Knowledge of ICD-9, CPT, HCPC, and Revenue Coding
• Experience with claims processing software and technology
• Understanding of medical terminology and healthcare industry regulations