Senior Claims Examiner

Job Summary

Managing a caseload of complex claims, the full-time Senior Claims Examiner will evaluate claim adjudication, identify coding errors and fraudulent practices, and recommend solutions to enhance claims processing efficiency.

Key responsibilities

• Evaluate claim adjudication to identify incorrect coding, abuse, and fraudulent billing practices
• Procure medical records and statements to support claims and manage a diverse caseload
• Monitor compliance with state and federal regulations while supporting departmental initiatives for improved efficiency

Required qualifications

• At least 2 years of experience in claims or customer service, preferably in a managed care setting
• Strong research and data entry skills
• Organizational skills with the ability to manage multiple projects and tasks
• Proficiency in Microsoft Office suite and applicable software programs
• Effective verbal and written communication skills