Senior Claims Examiner

Job Summary

A company is looking for a Senior Claims Examiner.

Key Responsibilities

• Process and adjudicate complex health care claims, ensuring accuracy and compliance with regulations
• Research and resolve discrepancies, including communication with providers and internal departments
• Mentor team members and lead training functions while participating in process improvement initiatives

Required Qualifications

• High school education or equivalent with 7-10 years of experience in health claims examination or a related field
• Extensive knowledge of medical and dental claim processing principles and procedures
• Advanced claims processing experience, including understanding of various claim types and regulations
• Ability to interpret Plan Documents and Summary Plan Descriptions for accurate claim adjudication
• Proficient in medical coding and relevant forms (UB-04, HCFA 1500) with knowledge of insurance plans