Senior Claims Examiner

Job Summary

A company is looking for a Senior Claims Examiner to process complex health care claims and mentor team members.

Key Responsibilities

• Adjudicate various types of health care claims and ensure compliance with policies and regulations
• Research and resolve discrepancies in claims, including communication with providers and members
• Lead process improvement initiatives and assist in training other team members

Required Qualifications

• High school education or equivalent with 5-7 years of experience as a health claims examiner
• Advanced claims processing experience with knowledge of various claim types and regulations
• Ability to interpret plan documents for accurate claim adjudication
• Proficiency in medical terminology and coding, along with familiarity with relevant forms
• Working knowledge of ERISA claims processing guidelines