Senior Claims Examiner

Job Summary

Senior Claims Examiner is a full-time remote position responsible for auditing claims for accuracy and compliance, managing escalated claims issues, and creating reports to track trends and quality opportunities.

Key Responsibilities

• Audit claims for accuracy, compliance, and proper adjudication
• Manage claims workflow and resolve escalated claims issues
• Create reports to monitor trends and support quality improvement efforts

Required Qualifications

• High school diploma/GED or equivalent working knowledge
• Three to four years of experience in Medical and/or Dental claims adjudication
• Strong understanding of medical terminology and coding (CPT, HCPCS, ICD-9/ICD-10)
• Working knowledge of Medicare, AHCCCS, and commercial insurance plans
• Previous claims auditing experience is preferred