Senior Claims Examiner

Job Summary

A company is looking for a Senior Claims Examiner.

Key Responsibilities

• Examine claim records and forms to investigate and resolve first-level disputes
• Review and process second-level claims, including adjustments and corrected claims
• Collaborate with leadership on trends related to improper processing and claim-related concerns

Required Qualifications

• Minimum of three years' health plan claims processing experience
• Two years' experience in health plan claims dispute analysis and resolution
• Experience in a Managed Care Plan (MCP) or PACE organization preferred
• In-depth experience with Medicare and Medicaid claims processing
• Proficient in managed health care principles, medical terminology, and industry pricing methodologies