Medical Claims Examiner

Job Summary

A company is looking for a Claims Examiner to evaluate insurance claims and determine compensation.

Key Responsibilities

• Review insurance claims for validity, completeness, and adherence to policy terms
• Analyze relevant documentation and policy coverage to determine liability and benefits
• Communicate with claimants and stakeholders to explain the claims process and provide updates

Required Qualifications

• High School diploma or equivalent required
• Medical claims processing experience required
• Knowledge of medical terminology and coding (ICD-9/ICS-10, CPT, HCPCS) preferred
• Familiarity with insurance policies and regulatory requirements preferred
• Ability to pass pre-employment background investigation and drug test